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| Features |
| Success against odds |
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by
Steve Nhlane, 03 January 2006
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07:15:27
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The first thing that conjures up in one’s mind on the mention of the country’s health sector are problems, high among them being shortage of drugs, lack of medical supplies, lack of basic medical equipment and infrastructure, support systems such as running water, electricity and telephones and shortage of human resource due to the brain-drain.
Health experts attribute the shortage of drugs in government hospitals to inadequate budget allocation and pilferage. The country’s annual drug budget is US$1 per capita, against US$3 for the region.
Pilferage is another cancer. Up to 60 percent of drugs bought by government, according to a study by the Department for International Development (DFID), don’t reach the target beneficiaries.
Dr Victor Mwapasa chairman of the Medical Ascociation of Malawi told the Scotland-Malawi conference in Edingburgh in Scotland last November that the country has a shortage of 4,736 health workers: 294 doctors, 3,723 nurses, 463 clinical officers and 256 laboratory technicians.
This, according to former Deputy Health Minister of Health Frank Mwenifumbo, translates into a 100 percent shortage of pathologists, 85 percent shortage of surgeons, 65 percent specialists, 71 percent anesthesiologists, 91 percent obstetricians, 92 percent paediatricians. It also means there is one doctor for 60,000 people instead of the World Health Organisation requirement of one doctor for 12,000 people.
According to Mwenifumbo, as of May last year, 15 of the country’s 28 districts were operating without a government doctor and five of them with no doctor at all.
During the past year, the staple of news from the country’s government hospitals have been reports about the failure of hospitals, including referrals—Kamuzu, Queen Elizabeth, Mzuzu and Zomba Central—to conduct surgical operations due to lack of drugs, gloves, reagents, Plaster of Paris (POP) and other materials.
Meanwhile, the infant death rate remains at 104 per 1,000 lives before the age of one year, while the death rate for children is a whopping 189 per 1,000. The mortality rate for mothers is 1,120 out of every 100,000.
HIV and Aids is claiming 10 lives per hour.
These statistics paint an uninviting picture of the country’s health sector. But it is against this backdrop that the country’s health workers, especially nurses in government hosiptals, have earned themselves the unenviable reputation of being uncaring for, unloving and harsh to patients and lacking passion for the job.
But despite these colosal problems dogging the country’s health sector and the lure of greener pasture overseas, there are many Malawian professionals in the sector who are selflessly giving out their best day in, day out to serve and save lives for the love of their country. And they are beating the odds. Their contributions, be it in research, training of health cadres and health care delivery services, is cause for a smile.
It is in this light that as Nation Publications celebrates successes in the health sector through the Nation Achiever project, we found it appropriate to mention a few professionals whose contributions are greatly impacting the lives of Malawians. We recognise the fact that there are many people who are doing commendable work that deserve mention but for limitations of space we are only able to mention a few.
Dr Newton Kumwenda
As Project Director of the College of Medicine—Johns Hopkins University Research Project, he established and expanded the Collaborative Research on HIV between the College of Medicine and Johns Hopkins University.
He expanded involvement of College of Medicine Staff from two part-time Malawian investigators to more than six full-time Malawian investigators. Project staff establishment increased from 20 in 1996 to about 200 presently.
He established a state-of-the-art clinical research laboratory at QECH which can conduct high quality medical research.
According to Kumwenda the following are some of the constraints facing research and public health practice:
-Lack of local qualified research scientists and staff; more local funding for health research from government or other agencies; more local biotechnology industry support to health or medical research;
-Limited regulatory support for health and medical research.
-Inability to share specialised services between local academic, government or other research institutions.
-Limited qualified public health professionals.
-Dearth of health professional organizations (Associations, societies etc) in the country to provide support or independent position on health policies or initiatives.
-Erosion of professional discipline and conduct among health workers.
Professor Mfutso Bengo
The world has put health on top of its agenda and clinical research is one way to bring about effective treatment of diseases.
Malawi, for example, is carrying out trials of Aids vaccine. And there is a lot of research going on in the country. Trials on human beings ought to be done with cautious, especially now when individuals can stand up and claim their rights.
Thus every clinical research has to include ethical considerations and be approved by the College of Medicine Research Ethics Committee (Comrec) whose right hand man is Joseph Matthews Mfutso Bengo, an associate professor of bioethics at the University of Malawi’s College of Medicine.
Apart from teaching at College of Medicine, Mfutso Bengo is a visiting professor of John Hopkins Fogarty bioethics training.
He has published in academic journals of such universities as Oxford and Havard.
Dr Nyengo Chiswakhata Mkandawire
An Orthopaedic Surgeon he is Senior Lecturer and Head of Department of Surgery. He has been Deputy Undergraduate Dean, College of Medicine in 2003. Currently, he is clinical director of the Malawi Orthopaedic Clinical Officer Training Programme—an 18-month diploma programme which trains orthopaedic clinical officers. Currently, orthopaedic clinical officers provide most orthopaedic services in Malawi especially at district hospital level for the rural masses. We graduate between 10-15 clinical officers every 18-months cycle.
Currently, Mkandawire is in the steering committee for the establishment of the faculty of Rehabilitation to train physiotherapists and occupational therapists in the College Medicine. He also provides specialist orthopaedic service to private patients at Mwaiwathu Private Hospital.
lHelped in establishing the Premedical Science Programme. This is an alternative entry route into Medical training to Supplement the traditional to supplement ‘traditional’ routes of ‘A’ level and 2nd year in a science course at Chancellor College.
lHelped in establishing postgraduate (specialist) training programmes in surgery in the College of Medicine. Specialists can now be trained locally to Masters Degree in Surgery and Orthopaedics.
lInvolved in teaching/training specialists in surgery and orthopaedics through the regional College of Surgeons of East Central and Southern Africa (Cosecsa).
Professor Jack Wilima
-Was influential in the foundation of Mwaiwathu Private which was officially opened in October 1998.
Main objectives of Mwaiwathu are:
-To provide high quality care to people of Malawi and neighbouring countries like Mozambique and Zambia.
-In the process of providing quality care, the hospital wanted to preserve forex in Malawi by reducing the number of patients who go abroad in search of high quality medical care.
-To contribute towards minimising brain drain of doctors by providing them an environment where they could do private work at the hospital to supplement their income.
-To contribute towards training of health personnel such as doctors, radiology and pharmacy technicians from government institutions.
-Was at one point chairman of National Malaria Control Committee which looked at anti-malaria resistance in Malawi and changed the treatment policy from Chloroquine to Fansidar.
-Together with Professor Mbvundula and Justice Elton Singini, he set up the Medical Council of Malawi in 1987.
-Took up leave of absence in 1998 to set up Mwaiwathu Private Hospital but still assist College of Medicine in administrative work and teaching students (for free).
Assessment
Health sector in Malawi in general is presenting major problems: —
-Man power is lacking, nurses leaving for greener pastures, training institutions not producing enough nurses
-Increased dearth of health personnel
-There is huge demand of health personnel in research projects etc but limited capacity to meet the demand.
-Huge gap between demand and supply.
-Increasing incidents of HIV which puts pressure on doctors to provide good services.
We will continue to complain about the brain drain. The problem is clearly known and yet there seems to be lack of will or capacity to institute changes to reverse this brain drain. It is alleged that even when donor funds are allocated specifically to improve packages for health service workers, administrators in Ministry of Health do not approve implementation for reasons best known to themselves. If the Health worker is valued then they must be remunerated accordingly!
-There is need to comprehensively review the ‘private-public’ partnership in Health Service Provision in government hospitals. Orthopaedic services can be improved immensely if private services charging appropriate tariffs commensurate with the facilities are provided. Such private services can subsidize the non-paying service resulting in overall improvement of patient care. Such partnership can also help in equipping and maintaining services in government hospitals.
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