A major limitation to healthcare provision in Malawi is the shortage of skilled healthcare workers – the vacancy rate for clinical staff is around 60 per cent.
For many years Médecins Sans Frontières (MSF) has been supporting the national health system to strengthen its HIV response through staff training and technical support and trying out innovative treatment models to reach more people with the virus.
In August, MSF and the health authorities in Chiradzulu district began a four-year handover process of a programme that opened in 1997. MSF continues to simplify HIV treatment: since September almost 50 per cent of people taking antiretrovirals (ARVs) in Chiradzulu have been on a six-month appointment schedule, which reduces the patient load and waiting times in the health centres. In addition, MSF is implementing a UNITAID-funded project using point-of-care tests to measure CD4 count (the CD4 count is an indicator of an HIV patient’s immunity level) and viral loads (rather than sending samples away to be tested) in Chiradzulu. By the end of the year, five health centres were testing for CD4 and four for viral load.
In Nsanje, MSF is supervising the implementation of a policy to put all HIV-positive pregnant and breastfeeding women on ARVs, regardless of their clinical status, to prevent transmission of the virus to their babies. The team is also developing a programme to treat tuberculosis (TB) in 14 health centres as a step towards integrated HIV–TB treatment. In addition, MSF is working to improve counselling, testing and treatment services for sex workers, couples in which only one person has HIV, adolescents, and people with advanced HIV.
The handover to the Ministry of Health of first-line HIV treatment in Thyolo was completed in December 2013, but MSF teams continue to mentor local staff who provide second-line treatments and viral load testing to patients. It is planned for the project to be handed over completely in 2015. During 2014, the combined MSF and Ministry of Health community team enrolled 4,200 people into community ARV groups, whereby people living with HIV take it in turns to collect medication on behalf of the group. More than 22,864 laboratory tests for viral load were carried out for patients in Nsanje and Thyolo.
Twelve students graduated from MSF’s Rural Human Resources for Health Scholarship Programme in 2014. They will work in the understaffed and hard-to-reach areas of Thyolo, Nsanje and Chikhawa.
MSF started a new project in two prisons: Maula in Lilongwe and Chichiri in Blantyre. Some 4,400 inmates and staff were screened for HIV, TB, hepatitis B and sexually transmitted infections (STIs). Treatment was provided for HIV, TB and the STIs, and people were vaccinated against hepatitis B. MSF undertook other activities to improve and expand prison health services, including providing training scholarships to four prison staff, constructing consultation rooms, pharmacies and laboratories as well as supporting general outpatient services.
In 2014, a project offering testing for HIV and STIs to truck drivers and commercial sex workers began in Mwanza and Zalewa, near the border with Mozambique. More than 300 sex workers and 50 truck drivers were tested.
No. staff in 2014: 586 | Expenditure: €7.1 million | Year MSF first worked in the country: 1986 | msf.org/malawi