Current health issues and progress in Malawi
Malawi is currently working towards achieving the Millennium Development Goals. To achieve the targets for the reduction of child mortality, which forms MDG 4, Malawi should reduce under-five deaths per 1,000 live births to 81, and increase measles immunisation to 100 per cent by 2015. In 2012, under-five mortality stood at 71 deaths per 1,000 live births, meaning that Malawi has now surpassed the under-five mortality target. In 2012 the measles immunisation rate stood at 90 per cent, showing a notable decrease since 2011, this suggests that improvement need to be made towards increasing and sustaining the measles immunisation programme if this target is to be achieved by 2015.
The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by three quarters between 1990 and 2015. When applying this target to Malawi, maternal mortality should fall to 275 cases per 100,000 live births. In the period 2007-11 Malawi had a reported maternal mortality ratio of 680 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 the period 2007-12 this figure stood at 71 per cent, so progress towards this target is also currently off track.
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 (TB), while levels of mortality from malaria have remained largely unchanged since 2001.
Accordingly, while progress overall towards MDG 6 is promising, dramatic progress is still required in all of these areas if the country is to achieve MDG 6.
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.
There is also a need to cater for those with special needs – for example, the elderly – and ensure that sufficient health services are delivered in friendly environments for these groups. Reproductive health services should facilitate universal access, 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.