USAID in Malawi has an extensive program aimed at supporting institutional strengthening of major health issues such as perpetual shortages of qualified health workers in facilities across the country, shortage of medication in public health facilities and high demand for health services, particularly among HIV/AIDS infected patients.
Implementing partners in strong collaboration with Right to Care Malawi are providing programmatic support in the areas of HIV/AIDS treatment, Tuberculosis (TB) and Prevention of Mother to Child Transmission in HIV (PMTCT). EQUIP and implementing partners have been able to rapidly improve patients being linked to care through Viral Load Scale up interventions, with a higher than above average success rate of 78.7% being linked into care and treatment. Retention, the cornerstone of patient longevity in care, is at 89% which is a huge achievement.
All facilities, in all EQUIP supported districts in Malawi, are implementing the 2016 Test & Start guidelines. This intervention is not without challenges and bottlenecks but local partners are training and implementing mentorship and site-by-site orientation. Human resources skilled in ART treatment and provision remain in short supply.
There are many innovations that EQUIP and its partners have employed in driving better care and treatment. These include the use of lay cadres of health care workers to support HIV testing in facilities, namely the HIV Diagnostic Assistants (HDAs) Community Health Workers. Over 600 HDA’s are currently employed by the EQUIP Consortium. A great benefit to the people of Malawi is the EQUIP strategy of testing people outside of normal clinic hours, such as on weekends. This has been done at some 84 facilities in Machinga, Mulanje, Phalombe and Zomba. Moonlight testing and the introduction of male friendly clinics all contribute to improved HIV programme management.
The EQUIP mechanism supports laboratories undertaking viral load testing and demand creation at facility level. Intensive Adherence Counselling and creating lists of patients who require their viral loads tested are important interventions, as is capacity building for health care workers and assisting with tools such as viral load registers
Malawi is already suffering from the negative effects of climate change, with extremely high temperatures occurring more frequently and precipitation patterns changing. In the coming decades, rainfall is likely to become more erratic and concentrated into heavy rainfall events that can cause flooding, temperatures will reach the heat threshold of some crops, and extended dry periods will become more common. These changes have major implications for human welfare and threaten to undermine development gains across sectors.
The Government of Malawi has established a goal to provide access to basic health services for all—a daunting task given widespread poverty and a predominantly rural and hard-to-reach population.
The country has a severe shortage of health workers, unhealthy behaviors, chronic malnutrition, frequent outbreaks of communicable diseases and limited access to quality health services, especially for the most vulnerable groups.