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Health System in Malawi

The topic of healthcare has become a worldwide focus in recent years. A push toward government-funded health services has indicated a shift towards the mentality that healthcare is a universal human right. Malawi, one of the smaller countries in southeast Africa, has a low gross domestic product, with 51.5 percent of the population living in poverty. With life expectancy at 64.5 years, the health system in Malawi needs improvement.

The Ouagadougou Declaration

In 2008, the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa was adopted by African Region Member states, which includes Malawi. This declaration focused on nine major issues within healthcare: health governance, service delivery, human resources, health financing, health information systems, new technologies, community ownership and participation, partnerships for development and funding for health research. The Ministry of Health in Malawi is responsible for the implementation and the regulation of these health entities.

Health System in Malawi

Currently, Malawi operates a three-tier health system. The first tier is primary healthcare. This sector is in effect to meet the needs of general medical care, which includes community and rural hospitals and maternity units. The second tier consists of district hospitals. These see patients who receive a referral from their primary care physician to receive specialized services. This includes laboratory work and rehabilitation services. The final tier is tertiary care provided by central hospitals. This tier covers extreme conditions that require highly specialized care such as treatment for specific diseases. The linkage for these services comes through an elaborate referral system that trickles down the health system.

Although the 2008 doctrine worked to lay out different measures to ensure the quality of health service delivery in Malawi, major health concerns still persist. HIV/AIDS continues to be the number one cause of death in Malawi: 21.7 percent of deaths in 2012 were linked to HIV/ AIDS. Acute Respiratory Infections account for 8.6 percent of deaths, while Malaria accounts for 40 percent of hospitalized individuals.

Issues With Funding

A large cause of a lack of quality health services in Malawi comes down to funding. Approximately $93 is spent on each person in Malawi annually, which is around 11.4 percent of the overall GDP. The U.S. spends around $10,000 on healthcare per capita annually.

Due to these issues, the focus for healthcare in Malawi has been working on minimizing the burden of disease, increasing cost effectiveness, providing more widespread access to the poor and implementing proven successful health intervention. Implementation has been laid out through new quality assurance policies, improving standards and accreditation, and improving performance management with the Health Strategic Plan, which was created in 2011. While the government in Malawi works to assure quality health services in Malawi, non-profit organizations are working to help provide those health services. A few of these organizations include Care, which has provided 30.2 million people in Malawi with sexual and reproductive health resources, and the Fistula Foundation, which has given over $300,000 of funding for physician training.

Work being done by the Malawian government and non-profit organizations around the world is helping to improve the health system in Malawi.

– Claire Bryan
Photo: Flickr

HIV and AIDS in South Africa

South Africa has the largest number of people living with HIV of any country in the world. South Africa comprises of approximately one-fifth of the 37 million people in the world living with HIV, with an estimated 7.2 million people living with HIV in 2017. This translates to a general population in which an estimated 18.8 percent of South Africans are HIV positive.

And yet, the country is making progress in reducing HIV and AIDS. In recent years, efforts to combat HIV and AIDS in South Africa have been ramped up. According to a study by the Human Sciences Research Council (HSRC), the statutory research agency of South Africa, there were 231,000 new HIV infections in 2017, representing a 44 percent decrease since the last major study in 2012.

Largest Antiretroviral Drug Campaign in the World

South Africa has the largest antiretroviral drug campaign in the world, which its own domestic resources largely fund. In 2015, South Africa was investing more than 1.34 billion (US dollars) towards its efforts to combat HIV and AIDS. And yet, it was not always like this; the South African government regarding and treating HIV and AIDS as a major and important public health issue and one to which it allocates resources to is a fairly recent phenomenon.

The government spearheaded this change, at least in part, by the exit of former South African President, Thabo Mbeki, who headed the government between June 14, 1999, and September 24, 2008. He had a track record of aversion to the combating of HIV as a public health issue and largely turned a blind eye to the issue. ‘“Many people do not remember that in 2000 there were only 90 people in South Africa on treatment,” said Michel Sidibé, executive director of UNAIDS.” When Mbeki left office in 2008, a tide turned and HIV and AIDS became to be regarded in the milieu and in public policy as a major and important public health issue, and now approximately four million people are receiving antiretroviral drug treatment in South Africa.

The 90 90 90 Plan

The 90 90 90 Plan summarizes some of the efforts to combat HIV and AIDS in South Africa. This plan aimed to test 90 percent of people so they would know their HIV status, followed by 90 percent of those diagnosed receiving sustained antiretroviral therapy and 90 percent of those receiving antiretroviral therapy to have viral suppression.

South Africa reached the first of the 90-90-90 targets, with 90 percent of people aware of their status, jumping up from only 66.2 percent in 2014. Of the affected, presently 61 percent of adults (people between ages 15-49) and 58 percent of children are on antiretroviral treatment, and so these current numbers are not at target though they are continuing to trend upwards. Life expectancy has seen a significant increase over the past several years, largely due to the efforts launched with antiretroviral therapy. There has been an improvement in life expectancy from 61.2 years in 2010 to 67.7 years in 2015.  With an increase of nearly 10 percent in just five years, one cannot overstate South Africa’s success in reducing HIV and AIDS within the country.

– Lacy Rab
Photo: Flickr