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MSF in Malawi, 2007
Field Staff: 652
Reason for intervention:
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HIV/AIDS is one of the most acute health concerns in Malawi. In this country of 13 million people, about one million are infected and 86,000 die each year. Despite intensive efforts by the authorities and international bodies, more than 170,000 people living with HIV in Malawi are still in urgent need of anti-retroviral treatment (ART).
MSF is supporting the implementation of a national HIV/AIDS plan. MSF is also closely involved in increasing the number and capacity of health centers to provide life-long care for HIV patients in the southern rural districts of Thyolo and Chiradzulu and in the central district of Dowa. In order to cope with an acute lack of doctors and other health professionals, the strategy has been to shift some functions to more junior staff such as health surveillance assistants. MSF has been focusing on increasing the skills of existing staff and lay people, including ‘expert patients’, to provide essential services.
Specially trained ‘expert patients’ and members of the community are now able to undertake testing and counseling as well as providing support to help people continue with their treatment. These tasks were traditionally undertaken by nurses but many became overwhelmed by the increasing number of HIV patients combined with a scarce workforce, so a complementary approach was needed.
Nurses can now focus purely on medical issues. MSF is providing HIV-related training for nurses, who are now able to prescribe ART, a responsibility previously performed only by clinical officers, medical assistants and doctors. The decentralization of HIV services together with the task shifting and intense training for care providers has allowed better follow up through smaller, more local health structures and home visits. Now patients do not have to travel long distances to hospitals for routine consultations and medication.
This decentralized approach has allowed MSF teams in Chiradzulu, Thyolo and Dowa to start more than 27,000 people on treatment.
MSF also strongly focuses on detecting and treating tuberculosis (TB) and malnutrition in HIV patients. Both conditions jeopardize the efficiency of HIV treatment. Over 1,700 people, many of whom were HIV positive, were admitted for TB treatment.
After more than seven years of working in Dowa district hospital in central Malawi, MSF has handed over its HIV/AIDS project to the Ministry of Health. This project started in 2000 with a strong focus on the prevention and treatment of sexually transmitted infections. In December 2004, the first patients started on ART. By the end of the project in October 2007, more than 1,100 HIV patients were undergoing treatment in Eastern Dowa and more than 270 in Mponela. It is estimated that over 3,300 patients have enrolled in the program over the last three years.
By December, approximately 19,000 people were still on treatment in MSF-supported structures across Malawi and more than 700 people were starting treatment in an MSF structure every month.
MSF has worked in Malawi since 1986.