Programme description

Title: Sustainable structures for the health sector
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Malawi
Lead executing agency: Ministry of Health (MoH)
Overall term: 2009 to 2015

Context

The capacity of the Malawian health sector is insufficient; the country suffers very high maternal and infant mortality rates. Malaria, tuberculosis and HIV/AIDS are other ubiquitous health problems. The major causes are extreme staff shortages, weak infrastructure and inadequate equipment in health facilities. The management of health services at central level and in the districts is ineffective and inefficient. Limited efficiency, motivation problems, a lack of supervisory capacities within public service, and weak democratic control play a central role.

Objective

The provision of primary health care services for the population is improved.

Approach

A joint programme by the Malawian government, donor countries and partner organisations (sector wide approach – SWAp) is intended to guarantee the availability of health services and ensure adequate primary medical care for the population. German development cooperation supports this programme by advising the Ministry of Health, improving the medical provision and facilitating human resource development.

Support for decentralisation in the health sector
Shifting responsibility and decision-making competences to the local level improves the quality of health services. The Ministry of Health is being advised on developing the relevant organisational structures and processes in the decentralisation process. The two programmes for health and democratic decentralisation are collaborating closely on this. Decentral institutions are reinforced organisationally and in the area of human resources. District health plans facilitate better planning and provision of resources. The districts are placed in a position to effectively administer their health budgets.
Zonal Health Support Offices (ZHSO) were created as a link between the political and implementing levels.

Cooperation with private and church-based health organisations
A coordinated set of rules applies to cooperation between government and private institutions. Non-governmental health services also receive government grants on this basis, enabling them to contribute to the provision of free primary care, particularly to the impoverished population in rural areas.

Human resource development
Because of the serious staff shortages in the Malawian health sector, the Centre for International Migration and Development (CIM) has supported the Malawian Ministry of Health for many years. Currently, 16 experts have been placed with the Ministry of Health and the medical faculties. Some of them take up senior positions in hospitals and support the training of doctors and clinical officers. The latter can carry out certain medical activities independently, thus making a considerable contribution to ensuring the provision of primary medical care. The training capacities for doctors and clinical officers at the universities are increased. The programme advises the human resource department of the Ministry of Health on introducing modern personnel development procedures. Promoting professional medical associations enables health staff to become actively involved in political debates and advocate for improved working conditions.

Results achieved so far

The Zonal Health Support Offices make valuable contributions to quality assurance in the subordinate health institutions and management structures.

More than half of the health budget goes directly to the districts. The funds are managed by district management teams under the responsibility of the local authorities, thus enabling local solutions to health problems to be developed and implemented, using funds more efficiently.

Since 2006, service contracts have been concluded between church-based and some private health institutions on the one hand and district administrations on the other hand. More than 60 cooperation projects have been created to date. Since then, health care for children, pregnant women and young mothers has been provided free of charge by the participating health centres and hospitals. This is financed by the joint Ministry of Health and donor fund. Malawi’s population thus has better access to primary health care services. One measure of this is the rising skilled birth attendance rate, which was more than 54 per cent in 2009.

The number of graduates from the universities’ medical faculties trebled between 2002 and 2008. The figures for nurses, midwives and other clinical officers are similar. There was an increase of 17 per cent in the number of new appointments in public service in 2008 in comparison with the previous year, alleviating the staff shortage to some extent.

Downloads

• Medical Dialogue between Traditional Experts and Biomedical Health Workers in Kasungu, Malawi
  Report for EPOS/GTZ/Aids Peer Review Group (2006)
  en-cooperation-traditional-experts-biomedical-health-workers-2006.pdf, 0.14 MB (English)
• Malawi-German Co-operation. Joint Strategy in the focal area Health
  BMZ & Ministry of Health (MoH) (2006)
  en-joint-strategy-health-bmz-moh-2006.pdf, 0.04 MB (English)
• Health workers income and expenditure in Malawi
  An assessment of the relative contribution of incentive schemes to take home pay and the extra living costs of rural posts (2009)
  en-health-worker-income-malawi-2009.pdf, 0.45 MB (English)
• Human Resources / Capacity Development within the Health Sector
  Needs Assessment Study (2007)
  en-capacity-development-needs-asessment-study-2007.pdf, 0.75 MB (English)
• Third Annual Malawi-German Health Forum – Report (2008)
  “Joining hands for better health care”
  en-third-malawi-german-health-forum-2008.pdf, 2.53 MB (English)
• Fourth Malawi German Health Forum (2009)
  “Improved management for better health”
  en-fourth-malawi-german-health-forum-2009.pdf, 3.52 MB (English)

Further information

• Local website of the programme
  Malawi German Health Programme
  http://www.mghp.net