Presented by Regina Soka Mankhamba
Diocesan Health Secretary, Mangochi Diocese, Malawi
Presented at the Marga Klompe Symposium on 16/11/2012 at
Tilburg University, Netherlands.
Background
 Malawi is a small, narrow and landlocked country and
shares boundaries with Zambia in the west,
Mozambique in the east, south and south west and
Tanzania in the north.
 In 2008, Malawi’s population was estimated at 13.1
million and growing at the rate of 2.8% per annum.
 one of the poorest countries in the world with a GDP
per capita at US$290 in 2009.
 Poverty levels are high: in 2009 the proportion of the
population living below the poverty line was estimated
at 39%.
DELIVERY OF HEALTH SERVICES IN
MALAWI
 In Malawi health care services are delivered by the
public and the private sector.
 The public sector includes all facilities under the
Ministry of Health, Ministry of Local Government and
Rural Development (MoLGRD), the Ministry of
Forestry, the Police, Prisons and the Army.
 The private sector consists of private for profit and
private not for profit providers (Christian Health
Association of Malawi). The public sector provides
services free of charge while the private sector charges
user fees for its services.
The objectives of the Health Sector
Strategic Plan.
 Increase coverage of the high quality Essential Health
Package services.
 Improve equity and efficiency in the delivery of quality
EHP services.
 Strengthen the performance of the health system to
support delivery of EHP services
The Essential Health Package
(EHP)
 An EHP for Malawi for the HSSP has been defined and it consists of the following
conditions:
 (i) HIV/AIDS;
 (ii) ARI;
 (iii) Malaria;
 (iv) Diarrhoeal diseases;
 (v) Perinatal conditions;
 (vi) NCDs including trauma;
 (vii) Tuberculosis;
 (viii) Malnutrition;
 (ix) Cancers;
 (x) Vaccine preventable diseases;
 (xi) Mental illness and epilepsy;
 (xii) Neglected Tropical Diseases (NTDs);
 (xiii) Eye, ear and skin infections. The interventions for each of these diseases are those
that have been proven cost effective. There are some interventions that are not cost
effective but have been included because they are necessary. The EHP will be provided free
of charge over the period of the HSSP.
Decentralisation of health services
 The provision and management of health services has since
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been devolved to Local governments following the
Decentralization Act (1997).
The district or CHAM hospitals provide general services,
PHC services and technical supervision to lower units
District hospitals also provide in service training for health
personnel and other support to community based health
Programs in the provision of EHP.
Health services are managed by the DHMT.
The DHMT receives direct technical support and
supervision from ZHSOs.
Challenges to Decentralisation
 Linkage to local government.
 The MOHP has been pursuing a strategy of “selective
deconcentration” whereby responsibility for certain functions
have been delegated downwards.
 Management capacity of DHMTs.
 District level staff have not been adequately trained to take on
extensive new management and planning responsibilities.
 Future status of vertical programs.
 The large number of vertical programs in the MOHP poses
challenges for effective decentralization. The reorganization
and integration of many of these programs will need to be
addressed. Programmatic guidance must be retained at the
central level.
 Linkage to the private sector.
 There is poor communication and coordination between
the public sector, the private non-profit sector, and forprofit sector.
 MOHP documents do not include a role for the private
sector (see Picazo and Marsh et al.1997).
Decentralization will require much greater coordination
between the public and private sectors. This includes
CHAM, private for-profit providers, MOLG clinics, and
large employers such as tea or tobacco estates.
What the Catholic Health Commission,
Mangochi Diocese is doing
Health promotion
 promoting behavioural change for healthier life style
 Promoting community action and participation through the Village
action committees in the communities
 Enabling Community Based Organizations for health promotion
delivery
Human resources for health
 Striving to provide human resource that is adequate, properly
trained, remunerated, well motivated and capable of
effectively delivering the EHP to the Malawi population.
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Strengthen human resource management for effective EHP delivery
at all levels
Improve retention of healthcare workers
Mala
South Bots Ghan Zamb Tanza wi
Cadre Africa wana
a
ia
nia
2004
Physi
cians
69.2 28.7
9
6.9
2.0
1.1
Nurse
s
388
241
64
113
35.0 25.5
Mala
wi
2009
2.0
36.8
Drugs and medical supplies
 Ensuring availability, equitable access and rational use
of good quality, safe, efficacious medicines and
supplies at affordable costs.
 Strengthening collaboration with stakeholders in the
pharmaceutical sector including the private sector.
Health financing to the CBOs
 To increase financial resources and allocate them
efficiently and equitably.
 Increasing overall financial resources at community
level to allow multiplier effect
 Improving efficiency and equity in financial resource
allocation; and utilization
 Promote community action and participation using
PBF approach
 Support the implementation of community action
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interventions to address prioritised EHP health
priorities
Strengthen and sustain health facility and community
structures in health promotion.
Train community based workers on their roles and
responsibilities.
Support community structures to plan, implement and
monitor health.
These settings are empowered to set priorities, make
decisions, plan strategies and implement them to
achieve better health for themselves using the existing
human and material resources.