The Malawi Communications Regulatory Authority (Macra) is ready to assist private broadcasting houses access equipment to meet the 2015 deadline to migrate from analogue to digital broadcasting. Since its formation in 2000, Macra has licensed 23 radio stations, two television stations, two fixed line telephone operators, three mobile operators and 15 internet service providers, among others.
Macra Acting Director General Mike Kuntiya disclosed this to the Media committee of Parliament on Tuesday. He said migrating from analogue to digital was a requirement that Malawi had to fulfil as members of the International Telecommunications Union (ITU) with the aim of improving broadcasting services. He said soon all broadcasting houses will be ordered to buy equipment for digital broadcasting to conform with the ITU requirement.
Mr Kuntiya said procuring equipment for digital broadcasting would be a financial burden for private broadcasters and Macra would come in to relieve them. “We will licence service providers to provide digital equipment to such broadcasters at a better fee,” Mr Kuntiya said.
Thursday, 20 August 2009
Persecuted by the government, informal workers in Malawi take a stand
Last week the repression of street traders in Malawi turned violent, as municipal officials in the city of Blantyre burned down vending stalls at a popular market. The Malawi Union for the Informal Sector (MUFIS), a War on Want partner organisation, is helping these informal workers gain compensation for their losses - and challenging the systematic persecution of those living on the margins of society.
On the morning of 11 August, street traders in the city of Blantyre in Malawi discovered that their stalls at a main city market had been burned to the ground by city officials. The stalls were the main source of income for these workers, who are part of the country's informal economy, a growing sector which supports millions of Malawians. The majority of the stalls that were set alight were run by women and youth with few job prospects.
Since adopting a series of liberal trade policies in the 1990s, Malawi's economy has suffered. Unable to compete with foreign imports, the Malawian industrial sector virtually collapsed, thrusting millions of workers into the informal economy, where they sell everything from handmade clothing to spare motor parts. Only 12% of the Malawian labour force is currently employed in the formal sector.
The workers' rights group MUFIS was founded in 2001 to support the rapidly growing number of workers in the informal economy. Without formal representation or bargaining power, many informal workers were being deprived of their basic rights and faced constant harassment. Through their national mobilisation campaign, MUFIS has grown considerably since its founding. The group now has 52 branches across Malawi and represents 6,500 workers. In addition to training street traders on their rights, MUFIS has also developed a platform for disenfranchised workers to express their concerns to policymakers.
In the days since the fire at Blantrye market, MUFIS officials have called on the government to compensate informal workers for their losses. MUFIS is also demanding protection for all informal workers from health hazards as well as acts of violence from government officials. War on Want stands by MUFIS's call for the protection of street traders, and expresses its support for all Malawian informal workers fighting for their rights.
On the morning of 11 August, street traders in the city of Blantyre in Malawi discovered that their stalls at a main city market had been burned to the ground by city officials. The stalls were the main source of income for these workers, who are part of the country's informal economy, a growing sector which supports millions of Malawians. The majority of the stalls that were set alight were run by women and youth with few job prospects.
Since adopting a series of liberal trade policies in the 1990s, Malawi's economy has suffered. Unable to compete with foreign imports, the Malawian industrial sector virtually collapsed, thrusting millions of workers into the informal economy, where they sell everything from handmade clothing to spare motor parts. Only 12% of the Malawian labour force is currently employed in the formal sector.
The workers' rights group MUFIS was founded in 2001 to support the rapidly growing number of workers in the informal economy. Without formal representation or bargaining power, many informal workers were being deprived of their basic rights and faced constant harassment. Through their national mobilisation campaign, MUFIS has grown considerably since its founding. The group now has 52 branches across Malawi and represents 6,500 workers. In addition to training street traders on their rights, MUFIS has also developed a platform for disenfranchised workers to express their concerns to policymakers.
In the days since the fire at Blantrye market, MUFIS officials have called on the government to compensate informal workers for their losses. MUFIS is also demanding protection for all informal workers from health hazards as well as acts of violence from government officials. War on Want stands by MUFIS's call for the protection of street traders, and expresses its support for all Malawian informal workers fighting for their rights.
Rehabilitation of Pediatric Ward at Malawi Hospital Will Improve Care For Children
A new grant to renovate the pediatric ward at Kamuzu Central Hospital is helping the Baylor International Pediatric AIDS Initiative and the Malawi Ministry of Health improve health services for all children seeking care at Kamuzu Central Hospital in Malawi.
The rehabilitation of the ward follows the opening of the Baylor Clinical Center of Excellence at Kamuzu, which provides state-of-the-art care for children with HIV.
Both of these programs are supported by the Abbott Fund, the philanthropic foundation of Abbott, the global health care company.
Kamuzu Central Hospital is the primary referral center for the central region of Malawi, which is estimated to have a population of 2.5 million children.
Currently, the hospital’s pediatric ward has 215 beds and admits an average of 859 children a month, or 28 children a day, limiting the capacity of children the hospital can serve
.
There are an estimated 88,000 children infected with HIV/AIDS in Malawi and 850,000 orphaned by the disease.
“The modernization of the Kamuzu pediatric ward is another step in the Abbott Fund's commitment to enhancing access to health care throughout the world,” said Catherine Babington, president of the Abbott Fund. “It will add critical and sustainable hospital capacity in Malawi, and provide higher quality care for pediatric patients.”
The Abbott Fund is providing $1.5 million to support this new effort.
Major goals of the rehabilitation include the reduction of patient crowding and transmission of diarrheal and respiratory illnesses, improvement of access to health care providers for patients, better resource allocation and creation of more space for efficient emergency services.
Construction began in early August 2009 and is anticipated to be completed by the end of December 2009.
“Malawi has one of the highest childhood mortality rates in children under age 5 in the world,” said Mike Mizwa, senior vice president and chief operating officer of BIPAI. “This excessive mortality can be attributed to both the direct effects of HIV/AIDS as well as compromised care of orphaned children or children whose parents are also ravaged by the infection.”
The hospital serves as a primary access point to identification, care and treatment of HIV/AIDS in Malawian children, and the much-needed renovations combined with the pediatric Center of Excellence are expected to improve management of pediatric HIV/AIDS care in the region.
The rehabilitation of the ward follows the opening of the Baylor Clinical Center of Excellence at Kamuzu, which provides state-of-the-art care for children with HIV.
Both of these programs are supported by the Abbott Fund, the philanthropic foundation of Abbott, the global health care company.
Kamuzu Central Hospital is the primary referral center for the central region of Malawi, which is estimated to have a population of 2.5 million children.
Currently, the hospital’s pediatric ward has 215 beds and admits an average of 859 children a month, or 28 children a day, limiting the capacity of children the hospital can serve
.
There are an estimated 88,000 children infected with HIV/AIDS in Malawi and 850,000 orphaned by the disease.
“The modernization of the Kamuzu pediatric ward is another step in the Abbott Fund's commitment to enhancing access to health care throughout the world,” said Catherine Babington, president of the Abbott Fund. “It will add critical and sustainable hospital capacity in Malawi, and provide higher quality care for pediatric patients.”
The Abbott Fund is providing $1.5 million to support this new effort.
Major goals of the rehabilitation include the reduction of patient crowding and transmission of diarrheal and respiratory illnesses, improvement of access to health care providers for patients, better resource allocation and creation of more space for efficient emergency services.
Construction began in early August 2009 and is anticipated to be completed by the end of December 2009.
“Malawi has one of the highest childhood mortality rates in children under age 5 in the world,” said Mike Mizwa, senior vice president and chief operating officer of BIPAI. “This excessive mortality can be attributed to both the direct effects of HIV/AIDS as well as compromised care of orphaned children or children whose parents are also ravaged by the infection.”
The hospital serves as a primary access point to identification, care and treatment of HIV/AIDS in Malawian children, and the much-needed renovations combined with the pediatric Center of Excellence are expected to improve management of pediatric HIV/AIDS care in the region.
US signs four grants with Malawi
The US government has through the United States African Development Foundation (USADF) signed four grants with Malawi that is set to support grassroot groups.
market in malawi
According to a press release from Washington DC, the four grants will benefit Malawi’s Lilongwe South Smallholder Farmers Association, Nkhata Bay Coffee Cooperative, Misuku Coffee Growers Cooperative Society and Coffee Growers Cooperative Society.
The four grants come barely a few days after Japan also signed an agricultural pact with Malawi which is expected to help boost the agricultural sector, the southern African country’s economic hub.
USADF president Lloyd Pierson said the funds will assist the groups at the grassroots level to help them produce more goods. “USADF funds groups at the grassroots level. These grants support farmers in Malawi to produce more goods to sell on markets, increasing their incomes and their quality of life,” said Pierson.
Lilongwe South Smallholder Farmers Association which is located in the country’s Capital city is an umbrella organization which supports more than 6,000 farmers from three farmer associations and that it works to improve the livelihoods of farmers by providing technical assistance in production and marketing of crops such as Soya, maize and beans. The association takes an active approach to create awareness of gender, literacy, environmental, and HIV/AIDS issues.
The four-year grant is expected to assist the association to construct a warehouse, develop a business plan and marketing strategy, purchase a van, drill a borehole, and enhance working capital.
Coffee market
Misuku Coffee Growers Cooperative Society which is situated in the northern region district of Chitipa assists farmers to grow and market coffee in the district and is said to have 727 members. The cooperative grows and raises Arabica coffee to improve the living standards of members and the local community. The three-year grant is expected to fund processing equipment, training, a trip to visit organic coffee farms in Tanzania, enhance the revolving loan fund in an effort to increase incomes and create jobs.
Nkhata Bay Coffee Cooperative which is also situated in the northern region district of Nkhata Bay and has 300 members. It grows and markets coffee and provides services and market access to farmers.
Its four-year grant is expected to fund the purchase of processing equipment and a truck, training, and enhance the revolving loan fund.
The last group Coffee Growers Cooperative Society is also situated in the northern region district of Rumphi and has 534 members out of which 123 are said to be women. The cooperative seeks to increase the incomes and value of life for its farmer members, their families, and the surrounding communities by increasing the volume of coffee produced and improving the yield of specialty coffee.
The cooperative has received a three-year grant which will finance construction of houses and processing equipment, training in agronomic practices and good governance, a truck, and office equipment.
USADF which is a US government agency established programming in Malawi last year and began funding projects this year. USADF receives co-funding from the government of Malawi and that the country’s current portfolio stands at nine investment projects totaling more than $1.5 million.
It is dedicated to expanding access to economic opportunity in Africa and that currently USADF operates in 20 African nations. Over the past 25 years, the agency has funded nearly 1,500 projects and invested the capital in excess of $150 million in support of African enterprises and local African communities.
market in malawi
According to a press release from Washington DC, the four grants will benefit Malawi’s Lilongwe South Smallholder Farmers Association, Nkhata Bay Coffee Cooperative, Misuku Coffee Growers Cooperative Society and Coffee Growers Cooperative Society.
The four grants come barely a few days after Japan also signed an agricultural pact with Malawi which is expected to help boost the agricultural sector, the southern African country’s economic hub.
USADF president Lloyd Pierson said the funds will assist the groups at the grassroots level to help them produce more goods. “USADF funds groups at the grassroots level. These grants support farmers in Malawi to produce more goods to sell on markets, increasing their incomes and their quality of life,” said Pierson.
Lilongwe South Smallholder Farmers Association which is located in the country’s Capital city is an umbrella organization which supports more than 6,000 farmers from three farmer associations and that it works to improve the livelihoods of farmers by providing technical assistance in production and marketing of crops such as Soya, maize and beans. The association takes an active approach to create awareness of gender, literacy, environmental, and HIV/AIDS issues.
The four-year grant is expected to assist the association to construct a warehouse, develop a business plan and marketing strategy, purchase a van, drill a borehole, and enhance working capital.
Coffee market
Misuku Coffee Growers Cooperative Society which is situated in the northern region district of Chitipa assists farmers to grow and market coffee in the district and is said to have 727 members. The cooperative grows and raises Arabica coffee to improve the living standards of members and the local community. The three-year grant is expected to fund processing equipment, training, a trip to visit organic coffee farms in Tanzania, enhance the revolving loan fund in an effort to increase incomes and create jobs.
Nkhata Bay Coffee Cooperative which is also situated in the northern region district of Nkhata Bay and has 300 members. It grows and markets coffee and provides services and market access to farmers.
Its four-year grant is expected to fund the purchase of processing equipment and a truck, training, and enhance the revolving loan fund.
The last group Coffee Growers Cooperative Society is also situated in the northern region district of Rumphi and has 534 members out of which 123 are said to be women. The cooperative seeks to increase the incomes and value of life for its farmer members, their families, and the surrounding communities by increasing the volume of coffee produced and improving the yield of specialty coffee.
The cooperative has received a three-year grant which will finance construction of houses and processing equipment, training in agronomic practices and good governance, a truck, and office equipment.
USADF which is a US government agency established programming in Malawi last year and began funding projects this year. USADF receives co-funding from the government of Malawi and that the country’s current portfolio stands at nine investment projects totaling more than $1.5 million.
It is dedicated to expanding access to economic opportunity in Africa and that currently USADF operates in 20 African nations. Over the past 25 years, the agency has funded nearly 1,500 projects and invested the capital in excess of $150 million in support of African enterprises and local African communities.
Zambezi Airlines, Air Malawi in partnership talks
ZAMBEZI Airlines’ growth strategy is focused on partnerships with other carriers in the region, chief executive officer Cornwell Muleya has said.
And Muleya has disclosed that Zambezi Airlines is currently in talks with Air Malawi for a possible partnership to enhance operations of the two airlines.
In an interview after the launch of the airline’s flights between Lusaka and Dar es Salaam, Muleya said partnerships were an important factor under the current economic environment.
“Partnerships are the best way to go in the times we find ourselves operating in…,” Muleya said.
He said the airline was in different stages of negotiations with several carriers in the region for strategic partnerships.
I can confirm for example that talks with Air Malawi have reached an advanced stage and you should be hearing an announcement concerning the same as early as next month,” said Muleya.
And Zambia’s High Commissioner to Tanzania Professor Royson Mukwena has appealed to the Zambian and Tanzanian tourist’ boards to develop packages that could bring great benefits to both countries.
During the launch of Zambezi Airlines’ flights between Lusaka and Dar es Salaam at a dinner in Dar es Salaam, High Commissioner Mukwena said there was need for the two countries to work together.
The Bilateral Services Agreement (BASA) that was signed between the two countries must serve as a launch pad not only for what we are witnessing today but better benefits to the peoples of the two countries. These benefits should translate into various economic benefits such as increased trade and investment, employment creation, poverty reduction and general stability in people’s standards of living,” said High Commissioner Mukwena. “Furthermore, the benefits should enhance and increase the contribution of the tourism sectors to economic growth of the two countries by increasing the number of local and foreign tourists to our attractive tourist destinations such as the Kilimanjaro and Nogorongoro crater in Tanzania and the mighty Victoria Falls and Kalambo Falls in Zambia to name but a few.”
And Muleya has disclosed that Zambezi Airlines is currently in talks with Air Malawi for a possible partnership to enhance operations of the two airlines.
In an interview after the launch of the airline’s flights between Lusaka and Dar es Salaam, Muleya said partnerships were an important factor under the current economic environment.
“Partnerships are the best way to go in the times we find ourselves operating in…,” Muleya said.
He said the airline was in different stages of negotiations with several carriers in the region for strategic partnerships.
I can confirm for example that talks with Air Malawi have reached an advanced stage and you should be hearing an announcement concerning the same as early as next month,” said Muleya.
And Zambia’s High Commissioner to Tanzania Professor Royson Mukwena has appealed to the Zambian and Tanzanian tourist’ boards to develop packages that could bring great benefits to both countries.
During the launch of Zambezi Airlines’ flights between Lusaka and Dar es Salaam at a dinner in Dar es Salaam, High Commissioner Mukwena said there was need for the two countries to work together.
The Bilateral Services Agreement (BASA) that was signed between the two countries must serve as a launch pad not only for what we are witnessing today but better benefits to the peoples of the two countries. These benefits should translate into various economic benefits such as increased trade and investment, employment creation, poverty reduction and general stability in people’s standards of living,” said High Commissioner Mukwena. “Furthermore, the benefits should enhance and increase the contribution of the tourism sectors to economic growth of the two countries by increasing the number of local and foreign tourists to our attractive tourist destinations such as the Kilimanjaro and Nogorongoro crater in Tanzania and the mighty Victoria Falls and Kalambo Falls in Zambia to name but a few.”
Malawi hails COMESA Regional Procurement Market
Malawi has hailed the establishment of a regional procurement market for the Common Market for Eastern and Southern Africa (COMESA) which is scheduled to be launched next month.
Under the regional procurement market, suppliers from anywhere within the member countries will be free to bid for tenders floated by any country for the procurement of public goods and services.
“The system would smoothen the flow of trade among member countries in the region because sometimes it does not make sense for these countries to import goods and services from Europe, Asia or America when the same can be sourced within the region,” said Malawi's director of procurement, Bright Mangulama.
COMESA project manager for procurement, Colas Ziki, disclosed during a week-long COMESA in-country capacity building workshop in public procurement administration in Lilongwe on Tuesday, 11 August 2009 that they have created a COMESA procurement website where member states can publicise their public procurement requirements that may be sourced within the region.
Since the Khartoum summit in 2003, member countries have been integrating their systems by modernising and harmonising them following guidelines from COMESA's Procurement Reforms and Capacity Project (EPRCP).
Under the regional procurement market, suppliers from anywhere within the member countries will be free to bid for tenders floated by any country for the procurement of public goods and services.
“The system would smoothen the flow of trade among member countries in the region because sometimes it does not make sense for these countries to import goods and services from Europe, Asia or America when the same can be sourced within the region,” said Malawi's director of procurement, Bright Mangulama.
COMESA project manager for procurement, Colas Ziki, disclosed during a week-long COMESA in-country capacity building workshop in public procurement administration in Lilongwe on Tuesday, 11 August 2009 that they have created a COMESA procurement website where member states can publicise their public procurement requirements that may be sourced within the region.
Since the Khartoum summit in 2003, member countries have been integrating their systems by modernising and harmonising them following guidelines from COMESA's Procurement Reforms and Capacity Project (EPRCP).
Climate extremes set to worsen in some, but not all, countries
Floods, droughts and heat waves – these are the kind of climate extremes that can bring devastation, particularly in developing countries. To make matters worse these extreme events are expected to become more frequent in some countries, due to global warming. Now a new study assesses which people are most vulnerable to climate volatility, and asks how we might reduce the impact of these extreme events.
For people living in Indonesia, the failure of a rice harvest can have serious consequences. Prices of this staple food are driven higher, making it impossible for poorer people to buy enough to eat. But while some families go hungry, others will manage to scrape by, and some may even benefit from the crisis. For the first time, researchers have assessed which nations and which groups of people are most at risk from climate volatility.
Syud Ahmed, from the Development Research Group at the World Bank in Washington DC, US, along with Noah Diffenbaugh and Thomas Hertel of Purdue University, US, combined global climate-model runs with statistical population data to assess the impacts on poverty of climate volatility for seven socio-economic groups in 16 developing countries from Asia, Africa and Latin America. They analysed the impact of one-in-thirty-year drought, flood and heat-wave events on each of the countries, focusing on two 30-year time slices: 1971–2000 and 2071–2100.
They found that all countries experienced increases in poverty rates after an extreme climate event, but some countries suffered more than others. In particular they showed that Bangladesh, Mexico, Indonesia, Mozambique, Malawi, Tanzania and Zambia are among countries with the highest shares of population that could enter poverty in the wake of extreme events.
What’s more Ahmed and colleagues found that urban labourers were likely to be the worst affected group. “Food is a major expenditure for urban poor and this group’s overall consumption falls with rising prices, which may push them below the poverty threshold of consumption,” Ahmed told environmentalresearchweb. By contrast, agricultural households tended to be less sensitive to climate extremes. “They are hurt by declines in agricultural productivity but the value of their farm output may rise due to higher food prices, increasing their incomes,” explained Ahmed, whose findings are published in Environmental Research Letters.
Using future climate-model runs Ahmed and colleagues discovered that the problem is likely to become worse in some countries and better in others. For example Tanzania currently experiences frequent extreme droughts, but in the future the intensity of these droughts is expected to decrease. “Tanzanian agriculture is almost completely rain-fed and thus highly sensitive to extreme dry spells,” said Ahmed. “Declines in the intensity of these poverty-inducing extreme-dry events would thus reduce the vulnerability of the population to be impoverished when a dry spell does occur.” Malawi, on the other hand, is expected to have more extreme-dry events in future, pushing greater numbers of people into poverty.
Understanding which countries are likely to be worst affected, and which groups of people are most vulnerable, will better enable people to prepare and perhaps mitigate the problem. For example, countries that are particularly vulnerable to extreme-dry events can focus on introducing better irrigation systems, or growing more drought-tolerant crops. In addition, governments and policy makers can try to improve a country’s infrastructure and economy to make people less vulnerable to extreme climate events.
For people living in Indonesia, the failure of a rice harvest can have serious consequences. Prices of this staple food are driven higher, making it impossible for poorer people to buy enough to eat. But while some families go hungry, others will manage to scrape by, and some may even benefit from the crisis. For the first time, researchers have assessed which nations and which groups of people are most at risk from climate volatility.
Syud Ahmed, from the Development Research Group at the World Bank in Washington DC, US, along with Noah Diffenbaugh and Thomas Hertel of Purdue University, US, combined global climate-model runs with statistical population data to assess the impacts on poverty of climate volatility for seven socio-economic groups in 16 developing countries from Asia, Africa and Latin America. They analysed the impact of one-in-thirty-year drought, flood and heat-wave events on each of the countries, focusing on two 30-year time slices: 1971–2000 and 2071–2100.
They found that all countries experienced increases in poverty rates after an extreme climate event, but some countries suffered more than others. In particular they showed that Bangladesh, Mexico, Indonesia, Mozambique, Malawi, Tanzania and Zambia are among countries with the highest shares of population that could enter poverty in the wake of extreme events.
What’s more Ahmed and colleagues found that urban labourers were likely to be the worst affected group. “Food is a major expenditure for urban poor and this group’s overall consumption falls with rising prices, which may push them below the poverty threshold of consumption,” Ahmed told environmentalresearchweb. By contrast, agricultural households tended to be less sensitive to climate extremes. “They are hurt by declines in agricultural productivity but the value of their farm output may rise due to higher food prices, increasing their incomes,” explained Ahmed, whose findings are published in Environmental Research Letters.
Using future climate-model runs Ahmed and colleagues discovered that the problem is likely to become worse in some countries and better in others. For example Tanzania currently experiences frequent extreme droughts, but in the future the intensity of these droughts is expected to decrease. “Tanzanian agriculture is almost completely rain-fed and thus highly sensitive to extreme dry spells,” said Ahmed. “Declines in the intensity of these poverty-inducing extreme-dry events would thus reduce the vulnerability of the population to be impoverished when a dry spell does occur.” Malawi, on the other hand, is expected to have more extreme-dry events in future, pushing greater numbers of people into poverty.
Understanding which countries are likely to be worst affected, and which groups of people are most vulnerable, will better enable people to prepare and perhaps mitigate the problem. For example, countries that are particularly vulnerable to extreme-dry events can focus on introducing better irrigation systems, or growing more drought-tolerant crops. In addition, governments and policy makers can try to improve a country’s infrastructure and economy to make people less vulnerable to extreme climate events.
In southern Malawi, decentralizing care to HIV/AIDS patients compensates for a lack of medical staff
Nearly one in seven people in the Chiradzulu district of southern Malawi is HIV-positive. MSF has been providing antiretroviral (ARV) there since August, 2001, and also treats AIDS related opportunistic illnesses, like tuberculosis.
With approximately 930,000 infected persons (adults and children), Malawi has one of the world's highest HIV/AIDS rates. Twelve percent of the population between the ages of 15 and 49 is affected and 68,000 people die from the disease every year. More than 13,000 of MSF's patients receive ARVs. But although 211 national facilities were offering ARVs free of charge by late 2008, only 50 percent of patients had access to the drugs and another 290,000 were still awaiting treatment.
"Every month, MSF places an additional 300 to 350 patients on ARVs," said Mickaël le Paih, the head of mission. "The needs are immense."
Cooperating, decentralizing, providing care closer to home
Given the extent of the needs and the shortage of health care staff - 40 percent of health care positions are vacant and very difficult to fill - Chiradzulu, and the rest of the country, required new treatment approaches.
*In collaboration with district health authorities, MSF simplified treatment protocols and delegated responsibility for treatment to the area's health care centers.
"In concrete terms, MSF medical staff work closely with Health Ministry staff in the health care centers on a daily basis," Mickaël le Paih explained. "That means we are sharing the work."
The goals of decentralized treatment are to ensure access to care and ARVs for the maximum number of the district's HIV patients and to provide services closer to home.
"Patients no longer have to walk miles to reach the hospital," said Séverine Doumeizel, the project coordinator. "They also receive better medical follow-up because in the event of complication, or if they don't feel well, it's simpler and faster for them to come back to the center."
Nouma leaves the MSF examination room at the Bilal health center. He entered MSF's program in 2008. Because he developed a resistance to the first-line drugs, he recently began taking second-line drugs.
"It was complicated to go to the district hospital," he said. "It is hard for me to walk and I don't have a car. And it's difficult to pay for transportation because it's far away. It takes me 30 minutes to reach the health center from my house.”
Creating accountability and delegating
To achieve the goal of reducing medical staff workloads - and thanks to treatment advances - some patients may be seen in the center twice a year and have their prescriptions renewed quarterly.
"There are several inclusion criteria for this program," explained Isaak, the project supervisor. "The patient must be taking a first-line treatment, must have followed the drug regime properly for more than a year and CD4 levels (markers of immunosuppression) must be above 350. If the patient is female, she must not be pregnant."
The idea is to emphasize treatment education for patients and to give them greater responsibility. In May 2009, 740 patients took advantage of this "streamlined" monitoring. In the event of a problem or complication, they may go directly to the health center, without waiting for their appointment date.
The strategy of assigning responsibilities to lower-level health care employees, and sometimes, to non-professionals, that are generally reserved to higher-level health professionals is widespread in developing countries. It is one way to deal with human resource shortages. In Malawi, some medical responsibilities have been delegated to nurses because of their greater number. They have been trained to initiate ARV treatment and monitor stable patients and can now provide care usually offered by physicians.
Only the most sensitive or complicated cases are referred to "clinical officers," health workers who have received four-years of medical training, but who are also in short supply.
Listening and Advising
Non-specialized, trained staff also handle screening and provide psychosocial and nutritional support. A patient taking ARVs must understand and specifically agree to continue the treatment for the rest of his or her life. This requires close and regular support, which is why MSF set up a counseling team to complement medical monitoring. The counselors are there to help patients with the daily problems that HIV poses and to ensure that they take their medications regularly.
Specific approaches have been set up for children, who represent 10 percent of patients. Communications tools intended for children ages 7 to 14 have been designed to provide them appropriate information on their illness.
"We know that it's important to get to the issue of HIV status quickly with children," says Violet, a psychosocial counselor. "And that means starting at the age of six. Most patients who learned about their illness after the age of 14 or 15 have a hard time taking their medicine properly. You have to talk with the children a lot and get involved with them."
What about the future?
All these evolutions have been conducted in close cooperation with the Ministry of Health. MSF expects to transfer increasing levels of responsibility to the agency.
"The decentralization goal was established in 2005," Le Paih said. "It's finally been achieved. Access to high-quality HIV care is available on a widespread basis throughout the Chiradzulu district. We're tempted to think about the longer-term now, which would, of course, involve the possibility of handing over MSF's activities over the course of several years."
But even if these innovative methods of delegating treatment responsibility provide relief to health staff and allow new patients to enter treatment quickly, they are not implemented on a national scale and do have limits.
"Even if the entire population could be screened tomorrow, the Ministry of Health would still face the human resources issue," Doumeizel noted. "And MSF cannot hire lots of people, for both financial and logistical reasons. The Ministry of Health must also continue to expand its ability to treat and monitor HIV patients."
In the meantime, MSF continues to develop programs like the prevention of mother-to-child HIV transmission (a transmission prevention program has been offered in these health centers since March 2008, using tritherapy on a prophylactic basis). Programs also include pediatric care and detecting treatment failures.
Thanks to MSF's program, more than 4,377 new patients received ARV treatment in Chiradzulu district in 2008. Since the project was initiated in 2001, MSF has monitored and treated about 13 000 patients.
With approximately 930,000 infected persons (adults and children), Malawi has one of the world's highest HIV/AIDS rates. Twelve percent of the population between the ages of 15 and 49 is affected and 68,000 people die from the disease every year. More than 13,000 of MSF's patients receive ARVs. But although 211 national facilities were offering ARVs free of charge by late 2008, only 50 percent of patients had access to the drugs and another 290,000 were still awaiting treatment.
"Every month, MSF places an additional 300 to 350 patients on ARVs," said Mickaël le Paih, the head of mission. "The needs are immense."
Cooperating, decentralizing, providing care closer to home
Given the extent of the needs and the shortage of health care staff - 40 percent of health care positions are vacant and very difficult to fill - Chiradzulu, and the rest of the country, required new treatment approaches.
*In collaboration with district health authorities, MSF simplified treatment protocols and delegated responsibility for treatment to the area's health care centers.
"In concrete terms, MSF medical staff work closely with Health Ministry staff in the health care centers on a daily basis," Mickaël le Paih explained. "That means we are sharing the work."
The goals of decentralized treatment are to ensure access to care and ARVs for the maximum number of the district's HIV patients and to provide services closer to home.
"Patients no longer have to walk miles to reach the hospital," said Séverine Doumeizel, the project coordinator. "They also receive better medical follow-up because in the event of complication, or if they don't feel well, it's simpler and faster for them to come back to the center."
Nouma leaves the MSF examination room at the Bilal health center. He entered MSF's program in 2008. Because he developed a resistance to the first-line drugs, he recently began taking second-line drugs.
"It was complicated to go to the district hospital," he said. "It is hard for me to walk and I don't have a car. And it's difficult to pay for transportation because it's far away. It takes me 30 minutes to reach the health center from my house.”
Creating accountability and delegating
To achieve the goal of reducing medical staff workloads - and thanks to treatment advances - some patients may be seen in the center twice a year and have their prescriptions renewed quarterly.
"There are several inclusion criteria for this program," explained Isaak, the project supervisor. "The patient must be taking a first-line treatment, must have followed the drug regime properly for more than a year and CD4 levels (markers of immunosuppression) must be above 350. If the patient is female, she must not be pregnant."
The idea is to emphasize treatment education for patients and to give them greater responsibility. In May 2009, 740 patients took advantage of this "streamlined" monitoring. In the event of a problem or complication, they may go directly to the health center, without waiting for their appointment date.
The strategy of assigning responsibilities to lower-level health care employees, and sometimes, to non-professionals, that are generally reserved to higher-level health professionals is widespread in developing countries. It is one way to deal with human resource shortages. In Malawi, some medical responsibilities have been delegated to nurses because of their greater number. They have been trained to initiate ARV treatment and monitor stable patients and can now provide care usually offered by physicians.
Only the most sensitive or complicated cases are referred to "clinical officers," health workers who have received four-years of medical training, but who are also in short supply.
Listening and Advising
Non-specialized, trained staff also handle screening and provide psychosocial and nutritional support. A patient taking ARVs must understand and specifically agree to continue the treatment for the rest of his or her life. This requires close and regular support, which is why MSF set up a counseling team to complement medical monitoring. The counselors are there to help patients with the daily problems that HIV poses and to ensure that they take their medications regularly.
Specific approaches have been set up for children, who represent 10 percent of patients. Communications tools intended for children ages 7 to 14 have been designed to provide them appropriate information on their illness.
"We know that it's important to get to the issue of HIV status quickly with children," says Violet, a psychosocial counselor. "And that means starting at the age of six. Most patients who learned about their illness after the age of 14 or 15 have a hard time taking their medicine properly. You have to talk with the children a lot and get involved with them."
What about the future?
All these evolutions have been conducted in close cooperation with the Ministry of Health. MSF expects to transfer increasing levels of responsibility to the agency.
"The decentralization goal was established in 2005," Le Paih said. "It's finally been achieved. Access to high-quality HIV care is available on a widespread basis throughout the Chiradzulu district. We're tempted to think about the longer-term now, which would, of course, involve the possibility of handing over MSF's activities over the course of several years."
But even if these innovative methods of delegating treatment responsibility provide relief to health staff and allow new patients to enter treatment quickly, they are not implemented on a national scale and do have limits.
"Even if the entire population could be screened tomorrow, the Ministry of Health would still face the human resources issue," Doumeizel noted. "And MSF cannot hire lots of people, for both financial and logistical reasons. The Ministry of Health must also continue to expand its ability to treat and monitor HIV patients."
In the meantime, MSF continues to develop programs like the prevention of mother-to-child HIV transmission (a transmission prevention program has been offered in these health centers since March 2008, using tritherapy on a prophylactic basis). Programs also include pediatric care and detecting treatment failures.
Thanks to MSF's program, more than 4,377 new patients received ARV treatment in Chiradzulu district in 2008. Since the project was initiated in 2001, MSF has monitored and treated about 13 000 patients.
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