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- Health care
Malawi has a three-tier health care system, based on a patient referral system. Primary care is mainly made up of community-based outreach, health posts, dispensaries, urban health centres and primary health centres. Primary level hospitals, with postnatal beds, outpatient services, maternity care and antenatal services, make up the remainder of the primary care level. Patients needing more sophisticated treatment are referred to secondary care, which is provided by the district hospitals in each of Malawi’s districts. These hospitals can provide the same basic services as the primary care facilities, but also have x-ray machines, ambulances, operating theatres and laboratories. The top tier of care comes from central referral hospitals located in the major urban areas. There are two at Blantyre and Zomba (Southern region), one in Lilongwe (Central) and one in Mzimba (Northern). Malawi has many pharmaceutical companies, predominantly small and medium enterprises, based in Lilongwe and Blantyre that are involved in the importation, distribution and retailing of medicines and medical supplies. Pharmaceuticals are exempt from import duty.
The underfunded and understaffed health services in Malawi are unable to meet the needs of the population, particularly outside urban areas. However, Malawi is developing a health financing strategy to help improve the funding available for health and move towards the goal of universal health coverage. Until now, the health system has been largely dependent on donor aid, which covered between 57% to 62% of total health expenditure between 2006 and 2009.
Public health care is generally free, but the cost of transportation can be prohibitive for many. A WHO report found that less than half of people in Malawi live within 5 km of some kind of health facility.
Post-2015 development agenda
The Malawi post-2015 development agenda addresses a number of challenges, including inadequate infrastructure, a shortage of drugs, ill-trained personnel and poor access to maternal health services. Other areas that have been highlighted as standing to benefit from greater attention include the number of health surveillance assistants (HSAs) available in the country, who would be able to assist rural communities in promoting health practices, and the suggested introduction of a new cadre of health care workers to function below the levels of HSAs. These would be community-based distribution agents (CBDAs), currently found in a limited capacity in some districts working as volunteers. CBDAs should be encouraged through training and incentive packages, employed in a paid capacity and dispersed throughout the country. Reproductive health services should be universally accessible, particularly given Malawi’s high rate of maternal mortality, and sexual health and counselling services should be more youth-friendly. The medicine procurement system needs to become more efficient and cost sharing should be promoted in hospitals.
Communicable diseases along with maternal, perinatal and nutritional conditions accounted for an estimated 65% of all mortality in Malawi in 2012. The prevalence of HIV in Malawi, as a percentage of people aged 15–49 years, stood at 10.3% in 2012. The prevalence of HIV peaked at around 16% in the period 1996–2000, following which it has shown a consistent rate of decline. In 2012 there were 1,564,984 reported cases of malaria. Estimated levels of mortality from malaria have seen a small overall decrease in the period 2006–12. Both the estimated incidence of and the estimated mortality (when mortality data excludes cases comorbid with HIV) from tuberculosis (TB) reduced by around half in the period 2000–13. Non-communicable diseases (NCDs) accounted for an estimated 28% of all mortality in 2012. The most prevalent NCDs in Malawi are cardiovascular diseases, which accounted for 12% of total deaths across all age groups in 2012. Cancer, non-communicable variants of respiratory diseases and diabetes contributed 5%, 2% and 1% to total mortality, respectively (2012).
In 2013 government expenditure on health was 4.2% of GDP. In the most recent survey, conducted between 1997 and 2010, there were two doctors, and 28 nurses and midwives per 100,000 people. Additionally, in 2010, 71% of births were attended by qualified health staff and in 2013, 88% of one-year-olds were immunised with a dose of measles. In 2014, 88% of people were using an improved drinking water source and 41% had access to adequate sanitation facilities.
Malawi was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1993 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination.
Pharmaceutical companies are a large part of the medical and health care sector in Malawi. Well known pharmaceutical companies in Malawi include Kabula Pharmacy, Pharma Chemie Ltd and Zedpharma.
In 2010 pharmaceutical imports represented 0.15% of Malawi’s total GDP; there were no pharmaceutical exports from the country for the same year.
The Malawi Central Medical Stores is responsible for the procurement, storage and distribution of all medical supplies to all approved institutions in Malawi, including the government of Malawi, and all private and public hospitals. All procurement is carried out according to the National Medicine List.
The Pharmaceuticals Services sector of the Malawi Ministry of Health is the central point of the pharmaceutical sector in the country, responsible for the organisation, management and administration for all pharmaceutical services. Malawi’s National Medicine Policy is in place to ensure that correct management and administration of pharmaceutical services is carried out in both the public and private sectors.
The most recent survey, conducted in the period 2000–11, reports that Malawi has two pharmaceutical personnel per 100,000 people.