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MSF in Malawi, 2009
Field Staff: 514
Reason for Intervention:
All articles on Malawi »
Malawi has been hit hard by the HIV/AIDS pandemic: nearly one million people, that is 12 per cent of those aged between 15 and 49 are infected. There is chronic shortage of health professionals and demand for antiretroviral therapy (ART) remains considerable. At the end of 2009, more than 300 centers were supplying ART to more than 183,000 patients, but 300,000 people were still on the waiting list.
Good-quality HIV care is now provided in the districts of Chiradzulu and Thyolo, but is rare throughout the rest of the country. Indeed the scale of the need combined with the shortage of health staff has led MSF to adjust its approach, simplifying treatment protocols and delegating patient care to nurses within local health structures to bring care closer to the patient’s home. Only where children and pregnant women are involved, or when there are complications, are cases referred to health specialists. Screening and psychosocial and nutritional support are provided by counselors who help patients follow the treatment properly.
MSF is working to provide further care for HIV patients, such as preventing mother-to-child transmission, detecting treatment failure and providing pediatric care. There is a strong emphasis on integrating HIV services with general services, and integrating MSF’s HIV support services into the Ministry of Health centers.
Since July 2009, the supply of ART drugs to Malawi has been unreliable. In response, MSF sent an emergency stock to the districts of Chiradzulu and Thyolo to help avoid any disruption to the medication of the 30,000 people on the program. Any breaks in treatment increase the risk of patients developing drug-resistance.
At the end of 2009, MSF was providing ART to more than 15,000 patients at Chiradzulu, and another 15,000 at Thyolo.
In July last year at the International AIDS Conference in Cape Town, South Africa, MSF gave a presentation on Malawi. This was an opportunity to show that offering ART on a larger scale need not increase the burden on the health system. The program in Thyolo, where 80 per cent of those in need have access to this life-saving care, was used as an example.
Shortage of staff
In Malawi the nurse and doctor-to-patient ratio is dangerously low. Medical staff in the districts where MSF works face high workloads: as many as 150 to 200 consultations a day. These shortages make it nearly impossible to provide good-quality healthcare and improve HIV services. One of the reasons why staff numbers are so low involves sickness and death that is often HIV-related. MSF has addressed this by supporting a clinic in Thyolo hospital where staff can receive health services.
Cholera outbreak in Lilongwe
The capital, Lilongwe, was hit by a cholera outbreak at the end of 2008 and in early 2009. The principal cause was the lack of access to safe water and sanitation. Authorities requested assistance and MSF provided supplies and medical staff and gave intensive training to health workers. Teams cared for more than 3,700 patients during the epidemic, and gave logistical support to improve water and sanitation services in nine health centers and one district hospital.
Earthquake in the north of the country
On December 20, an earthquake of magnitude 6.2 hit the rural province of Karonga in the north of the country, killing four and injuring 200 people. Some 1,500 people were made homeless. Since the financial and material assistance provided by other agencies was adequate, MSF focused more on technical support, setting up a health center in the camp for those who had been made homeless and providing sanitation and access to drinking water. The team also ensured that the earthquake victims had access to HIV care.
Nouma, MSF patient from Chiradzulu
‘It was difficult for me to get to the district hospital. I have difficulty walking and don’t have a vehicle. Finding the money for transport is a problem too because it’s a long way to go. Now, I just need 30 minutes to get to the health center.’
MSF has worked in Malawi since 1986.