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Issue

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Action

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Issue

© UNICEF Malawi/2010/Noorani

One of the factors that contributed to the decline of the infant and under-five mortality rates is sustained high coverage of immunization.

Child Mortality
Malawi is on track to achieve the Millennium Development Goal (MDG #4) on reducing child mortality. The 2006 Malawi Multiple Indicator Cluster Survey (MICS) showed a sharp decline in the infant and under-five mortality rates, from 104 and 189 per 1,000 live births respectively in 2000 to 72 and 122 in 2006. Factors that contributed to the decline include sustained high coverage of immunization and vitamin A supplementation, elimination of neonatal tetanus, malaria control activities and increased rates of exclusive breastfeeding and access to safe drinking water.

The immediate and most common causes of infant and child mortality and morbidity are neonatal conditions, pneumonia, diarrhoea, malaria, AIDS and malnutrition. Though Malawi is on track to achieve a two-thirds reduction in infant and under-five mortality by 2015, the current efforts need to be sustained and scaled up in some areas in order to maintain the current trend.

Maternal Mortality
At 807 per 100,000 live births, Malawi’s maternal mortality ratio is one of the highest in the world. The main causes include haemorrhage, sepsis, pregnancy-induced hypertension, obstructed labour and complications of abortions. Indirect causes include malaria and nutritional deficiencies. The underlying causes of children’s and women’s poor health include inadequate knowledge and caring capacities on the part of caregivers and low access to quality health services.

Nutrition
The MICS showed that there has been fewer improvements in children’s nutritional status in Malawi since 1992: 46 per cent of under-five children are stunted, 21 per cent are underweight, and 4 per cent are wasted. The 2001 Micronutrient Survey by the Ministry of Health revealed that 59 per cent of under-five children and 57 per cent of non-pregnant women have sub-clinical vitamin A deficiency. In addition, 80 per cent of under-five children and 27 per cent of non-pregnant women were found to have anaemia.

The causes of malnutrition include lack of knowledge about child-care practices, inadequate diet, frequent incidences of disease among young children, and the low socio-economic status and poor nutritional condition of most mothers. Up to 50 per cent of identified acute malnutrition is associated with HIV.

© UNICEF Malawi/2010/Noorani

The underlying causes of children’s and women’s poor health include inadequate knowledge and caring capacities on the part of caregivers and low access to quality health services.

HIV and AIDS

HIV prevalence among adults aged 15-49 years is estimated at 12.6 per cent. An estimated one million people are living with HIV. Mother-to-child transmission accounts for close to 30,000 infections among newborns annually, and about 24 per cent of pregnant women attending antenatal clinics are accessing services to prevent transmission of the virus. An estimated 89,000 children are living with HIV, of whom 24,000 require antiretroviral (ARV) treatment. A rapid roll-out of the national AIDS treatment programme has helped to put about 160,000 adults on ARV treatment and 12,000 children. Of Malawi’s one million orphans, 500,000 have lost one or both parents to AIDS.  Without parental protection, these children are exposed to neglect, abuse and exploitation and lack access to basic necessities and services.

Health Systems Capacity and Financing

Malawi's weak health system has affected the availability, access, utilisation and quality of health services delivered at all levels. Essential commodities are often out of stock at the point of use and the supply management chain remains weak. There is a serious shortage of qualified and motivated staff, many of them having gone elsewhere in search of better pay. The World Health Organization estimates that the country had 266 physicians in 2004 with a density of 0.02 and 7,264 nurses with a density of 0.59. The country has only two paediatricians per 100,000 inhabitants, compared with 222 in the United Kingdom and 74.3 in South Africa. The minimum WHO standard is 20. Malawi's cadre of nurses per 100,000 inhabitants ranks at a paltry 56.4, much less than the 1,170 in the United Kingdom and 393 in South Africa.

Efforts to reduce this shortfall have resulted in improvements in the vacancy rate from 61 percent in 2005/06 to 49 percent in 2006/07. This is largely due to salary increases for health workers and the recruitment of close to 11,000 Health Surveillance Assistants. In addition, there is an overall increase by 24 percent of skilled health staff in the sector, with 40 percent of health facilities now having the minimum required number of nurses compared to 23 percent in 2002.

In 2002, Malawi adopted the Essential Health Package (EHP), a clearly defined and costed package of key interventions which serves as the basis for pooled funding to the health sector. The objectives of the EHP were to contribute to reduced poverty in Malawi, to increase the efficiency of publicly funded health services, to improve equity of access to health services, to serve as a tool for priority setting and the basis for a Sector-Wide Approach, and to enhance a shared vision of the health sector in terms of what should be supported with public funds and external support. The EHP addresses the major causes of disease and death in Malawi: vaccine-preventable diseases, malaria, maternal and neonatal morbidity and mortality, tuberculosis, acute respiratory infections, acute diarrhoeal diseases, sexually transmitted infections, schistosomiasis, nutritional deficiencies, eye, ear and skin infections, and common injuries. The EHP was costed at US$17.53 per capita or a total of US$210 million a year of which the Government pledged to contribute US$50 million a year with donors expected to meet the shortfall. In 2007, the EHP was revised to include Accelerated Child Survival and Development and recosted at a per capita expenditure of  US$28.

Exitsting mechanisms for financing the health sector include the national treasury and the health sector SWAp. Malawi's health expenditure as a proportion of the GDP has risen steadily from 7 per cent in the 1998/99 financial year to 10.3 per cent in the 2008/09 financial year.