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. Mental health legislation was most recently revised in 2005, although there is no officially approved mental health policy or act. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Malawi to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to 82 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 68 deaths per 1,000 live births, meaning that Malawi has now surpassed the under-five mortality target. In 2013 the measles immunisation rate was 88 per cent, suggesting that improvements need to be made towards increasing and sustaining the measles immunisation programme if this target is to be met when the 2015 data is analysed. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Malawi, maternal mortality should fall to 275 cases per 100,000 live births. In the period 2007–11 Malawi had an adjusted maternal mortality ratio of 510 deaths per 100,000 live births (this figure was estimated at 460 deaths per 100,000 by UN agencies/World Bank in 2010). Based on the data reported by the country, this target is far from being met. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2010 this figure stood at 71 per cent, so achievement of this target is not looking realistic. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other communicable diseases. Malawi’s prevalence of HIV was 10.8 per cent in 2012 (in the 15–49 age group). While this figure is very high, there has been a consistent reduction in HIV prevalence since 2000. Since 1998 there has been a significant decline in estimated incidence of and mortality (when mortality data excludes cases comorbid with HIV) from tuberculosis, while levels of mortality from malaria have remained largely unchanged since 2001. However, occurrences of malaria hit a high of 1,564,984 in 2012, compared to 304,499 in 2011. Accordingly, while overall headway towards MDG 6 is promising, dramatic progress is still required in all of these areas if the country is to achieve MDG 6. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Malawi’s public spending on health was 6.2 per cent of GDP in 2011, equivalent to US$31 per capita. Roughly a quarter of health care in Malawi (23 per cent) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 9.2 per cent of GDP in 2012, of which 77 per cent (US$19 per capita) was covered by the government. Ma l awi 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 per cent to 62 per cent 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. 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 youthfriendly. The medicine procurement system needs to become more efficient and cost sharing should be promoted in hospitals. 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. Care of the elderly: Around 523,000 people in Malawi are over the age of 65 – three per cent of the total population (2013). At the age of 60 a person living in Malawi can be expected to live for an additional 17 years, on average (2013). Overall, public pension spending is equivalent to 1.4 per cent of the country’s total economic output (2012). The government has acknowledged a need to do more for those with special needs – including the elderly – ensuring that Population over 65 3% Commonwealth Health Partnerships 2015 201
Commonwealth Health Partnerships 2015
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