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MSF in Malawi, 2008
Field Staff: 700
Reason for Intervention:
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In recent years, the Malawi government has made increasing efforts to provide more antiretroviral (ARV) therapy in response to the spread of HIV/AIDS. An estimated 12 percent of the adult population are infected. But there is still an acute shortage of nurses and doctors, which means many people are still going untreated.
Tackling the HIV/AIDS problem
Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing ART in two southern rural districts: Chiradzulu since 2001; and Thyolo since 2003. Since these projects began, MSF has started more than 28,000 patients on ART—12,000 in Chiradzulu and 16,000 in Thyolo. In 2007, MSF achieved its goal of providing universal access to ARV therapy in Thyolo, starting 11,520 people on the therapy. In 2008, MSF placed more than 4,300 new patients on ARV therapy in Chiradzulu, and more than 4,400 in Thyolo.
MSF is involved in increasing the number and capacity of health centers in the two districts. In 25 health centers, ministry of health staff have been trained to prescribe ARV therapy and to give follow-up treatment to patients who are in a stable condition.
Prevention of mother-to-child transmission services are available in 20 locations in Thyolo, and in 10 health centers in Chiradzulu. Since the incidence of HIV-tuberculosis (TB) co-infection is high in Malawi, MSF has also been active in identifying potential patients and providing early diagnosis of TB.
In 2008, the MSF team in Chiradzulu carried out an assessment of patients who had abandoned their treatment, finding and interviewing them to discover why they had not finished the course. The main reasons involved the stigma associated with the disease expressed by their family or community, lack of information about the medication or the disease itself, or a perceived overall improvement in their health.
MSF is collaborating with local health authorities to implement a national HIV/AIDS treatment plan. Through technical working groups at the national level, MSF has participated in the development of healthcare protocols and guidelines that have been disseminated nationwide.
"HIV/AIDS is not just a medical problem. It is also a cultural, social problem. We want to enable people to take responsibility themselves. To do this we have started giving communities a lot of information about HIV/AIDS, such as where to find services, how to address problems associated with taking the drugs, how to stay healthy," explained Jomah Kollie, MSF community program manager.
Task-shifting and decentralization of services
To retain existing patients and to cope with an increasing caseload, MSF has focused on training nurses to prescribe ARV therapy—a responsibility previously carried out only by clinical officers, medical assistants, and doctors.
MSF has decentralized some services to fixed locations in more rural areas in order to reduce the distance that patients have to travel for routine consultations and medication. Nurses treat opportunistic infections and chronic diseases, and lay counselors and dedicated volunteers from the community, often HIV-positive themselves, undertake testing and counseling duties. The counselors and volunteers also provide other essential services, such as helping people to adhere to treatment and tracing patients who have stopped coming for treatment. Advances in treatment methods now also allow patients who are in a stable condition, and who have been on treatment for at least a year, to have their medical consultations only every six months as opposed to every two to three months.
In November 2008, a cholera epidemic swept through the country. MSF intervened in three rural districts, as well as in the capital Lilongwe. MSF provided care for more than 3,700 patients during the epidemic, and logistical support to improve water and sanitation services in nine health centers and one district hospital. MSF also trained local medical and logistical staff, supported a health center in Blantyre, and carried out situation assessments on the border to Mozambique.
MSF has worked in Malawi since 1986.