Mangochi-ICEIDA-Partnership-in-Public-Health-2012-2016-Part-II ...

MANGOCHI ICEIDA PARTNERSHIP IN PUBLIC HEALTH – PROGRAMME DOCUMENT 2012-2016
disinfection. Health facilities need to have a preparedness strategy (cholera tent and beds) as they
can expect to receive a large case load needing emergency hospitalisation and treatment.
2.3.3. Health Support Systems
System support refers to quality assurance. The main strategies are training of health personnel,
supportive supervision of service delivery, reliable information system and a functioning
pharmaceutical supply chain. Financial planning and management are also important components.
Generally speaking support systems at the district level are weak in Malawi. Strengthening the
systems is one of the priorities of the MoH for the coming years. Personnel at district level require
capacity building, better access to computers and internet services and improved office space.
Training of CHWs is incomplete in Mangochi but a lot of effort has been put into mending this
situation recently and this effort will continue. Training for improved maternal and neonatal health
care services is also planned.
The MoH recognises the need to improve supervision structures and mechanisms at all levels of the
system. The current set-up in Mangochi, under the DEHO, has zonal coordinators based at the DHO
and cluster supervisors based in key health facilities as presented in Annex 5. The five health zones
are divided in nine clusters for this purpose. Programme specific supervision is performed by
programme coordinators. There are various constraints in accomplishing regular supervision of all
health facilities and personnel, including lack of transport and fuel.
While systems for monitoring and evaluation are in place, challenges exist, which impact on the
effective functioning of the HMIS, such as low data quality due to infrequent data validation
exercises (HSSP). Furthermore, Malawi still needs a coherent system for registering births and deaths
(civil statistics). There is a potential for collecting such data through the HSAs, that is, with
implementation of village health registers. If the information is to be reliable however there must be
regular quality assurance.
The National Commission on Science and Technology (NCST) regulates the conduct of research in
Malawi. Challenges exist, which include the absence of legal and policy frameworks to regulate
research, weak coordination and monitoring of research being carried out in Malawi and poor
utilisation of research findings for practice and policy formulation due to limited interactions
between researchers and potential users of the information (source: HSSP).
Finally, complaints of irregular and insufficient supply of drugs and materials are common and
financial planning at district level is weak. These problems are addressed in HSSP 2011-2016.
2.4. Budget and Financing
In 2003 it was estimated that the cost to meet total health expenditure in Malawi was about USD 35
per capita (Indicator Handbook). The estimated budget needed for delivery of EHP services was USD
17 per capita. At the time current expenditure on health was USD 12 per capita.
In 2004 GoM established a plan of action for the period 2004 to 2010, which was implemented using
the Sector Wide Approach (SWAp). According to the HSSP, government spending on health increased
from 2004/2005 to reach a high at 2009/2010 and then declined. Overall health spending was USD
5.3 per capita in fiscal year 2004/2005, 16.3 in 2008/2009 and 14.5 in 2009/2010. Donor funding rose
but less was disbursed in 2008/2009 than planned. Significant amount of donor funds remain off
budget and donors still fund NGOs on interventions that are not priority in the sector. Poor
alignment of health development partners with financial systems is a problem. Absorption of funds
at MoH headquarters, especially in infrastructure, is low due to procurement bottlenecks.
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