And unfortunately, I mean killer, although there is progress to report too. This cup half full/half empty analysis comes from a new country study for Oxfam’s Essential Health Services Campaign.
The good news:
- Increased funding and new policies to ensure greater access to health care have resulted in some successes – with nearly a third more children able to see their fifth birthday today than eight years ago.
- Much of the progress is down to the Malawian government’s launch of a basic ‘Essential Health Package’ in 2002. This aims to provide free access to essential health care in government clinics in order to treat some of the main ill-health problems in Malawi, such as malaria, diarrhoea, and respiratory infections. This has been a major breakthrough – in one hospital in the Dowa district, making maternal care free resulted in a 30 per cent increase in antenatal visits, and a 44 per cent increase in assisted deliveries. The World Bank has cited the EHP as one of the key reasons why health provision is more equitable in Malawi than in other African countries.
- The EHP has been part of a four-fold increase in overall national health spending (including spending for HIV and AIDS), between 2002 and 2006, accounting for approximately 10 per cent of total government expenditure. The Malawian government is expected to exceed the Abuja commitment of spending 15 per cent of their national budget on health from 2007–2008.
Close to 130,000 people countrywide are now on vital anti-retroviral therapy (ART) for HIV, up from virtually nil only five years ago.
But an awful lot of bad news remains:
- Life expectancy is 46 years.
- The infant mortality rate remains high and on average one woman in every hundred will die in pregnancy or childbirth.
- There are only 252 doctors for the entire population of 13 million. There are four qualified dentists working in the health system.
- The nursing to population ratio in Malawi is 1:3500, compared to 1:1000 in Africa as a whole, and 1:102 in Germany
- 25–30 per cent of health professionals will die of AIDS in the next decade,
- Per capita spending on health in Malawi is approximately $14 per year. Spending by households on health care is very high: approximately $4 comes from out-of-pocket expenditures, $4 from government, and $6 from donors. Funding for health is $20 short of the $34 dollars per capita proposed by the Commission for Macroeconomics and Health.