Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
Figure 25. Cumulative ART Registrations by Quarter, 2004-2009
350,000
300,000
250,000
200,000
150,000
100,000
50,000
‐
Q4 ‐ 2004
Q1 ‐ 2005
Q2 ‐ 2005
Q3 ‐ 2005
Q4 ‐ 2005
Q1 ‐ 2006
Q2 ‐ 2006
Q3 ‐ 2006
Q4 ‐ 2006
Q1 ‐ 2007
Q2 ‐ 2007
Q3 ‐ 2007
Q4 ‐ 2007
Q1 ‐ 2008
Q2 ‐ 2008
Q3 ‐ 2008
Q4 ‐ 2008
Q1 ‐ 2009
Q2 ‐ 2009
Q3 ‐ 2009
Source: Quarterly Reports on Antiretroviral Treatment in Malawi
Public Facilities
In addition to the scale-up of health services, the number of facilities capable of
providing the Essential Health Package (EHP) on-site has increased dramatically. A 2003
assessment conducted jointly by the Japan International Cooperation Agency (JICA) and
the MOH determined that only 54 of 585 (9%) of MOH and CHAM facilities were
capable of providing the EHP. 94 By 2009, this figure had increased to 74%. 95
One important factor that can also have an impact on service utilisation is the signing of
Service Level Agreements (SLAs) between the MOH and CHAM. The purpose of the
SLAs is to provide free access for the public to services in the Essential Health Package
at CHAM facilities, thus removing user fees for the public and increasing demand for
services. Initially begun in 2002, the SLAs now cover 68 of the 173 CHAM facilities in
the country. The majority of SLAs were signed in 2006 and 2007, with contracts renewed
at regular intervals to account for increasing costs of service delivery. A report
undertaken by the CHAM Secretariat showed that utilisation increased dramatically after
the introduction of SLAs. 96 Although waiving user fees increase demand, the supply side
94
Hozumi D. 2003. Status of Health Services Facilities in Malawi: Findings from Preliminary Analysis of
the Malawi Health Facility Survey 2002. Ministry of Health and Population, Malawi, (April).
95
Malawi Health Sector-Wide Approach (SWAp) Programme of Work (PoW) Framework. Indicator
Matrix for Financial Year 2008-2009). 8 October 2009.
96
Monitoring Report on the Implementation of Service Level Agreements in Selected CHAM Units.
Christian Health Association of Malawi (CHAM), December 2008.
EHRP Evaluation Final Report Page 63
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