Malawi’s healthcare system faces multiple obstacles including a poor infrastructure, the shortage of life-saving drugs, depleted equipment in most health facilities and employment issues. The system was also badly hit by Tropical Cyclone Freddy which killed over 1,200 people and destroyed healthcare facilities among other buildings as well as having to deal with the deadliest cholera outbreak in the country’s history that has claimed over 2,000 lives.
With a population of almost 20 million, Malawi has a total of 501 healthcare facilities according to government data. Of these, 328 are health centers, 24 are district hospitals and there is a central hospital in just 4 cities providing tertiary care. Health centers provide primary health care at district level while district hospitals provide secondary health care.
In an attempt to extend access to health care services, the Malawi government announced the construction of 900 health posts offering primary health care across the country but only 55 are actually under construction, Health Ministry Secretary Samson Mndolo said.
The situation is far from being any better in terms of medical equipment. When contacted by DevelopmentAid, Zaziwe Gunda, a Society of Medical Doctors spokesperson, said that equipment, ambulances and other utility vehicles are seldomly serviced and maintained at most Malawi hospitals noting that they are very obsolete and need to be replaced.
Drug shortage is yet one more issue faced by Malawi’s healthcare facilities. Prince Chirwa, the director of Health and Social Services for Mzimba South, noted that stockouts were largely due to procurement delays, low drug budgets and drug theft. The Covid pandemic worsened the situation leaving the country facing acute drug shortages for months and even one year in the case of specific drugs. Although the government increased the budget allocation for medication procurement in the 2022-2023, district hospitals continue to report drug stockouts.
To provide a broader picture of the state of affairs in the healthcare sector, Gunda noted that most Malawians walk as far as 20 kilometers to access healthcare services.
“Firstly, the budget for the health sector has taken a downward trend in recent years and so has the drug budget for the district. Secondly, insufficient forex in the country is contributing to the lack of essential medication for patients and this includes cancer medications that are very expensive yet lifesaving.”
In addition to these obstacles, there is a staff shortage which is the result of financial issues rather than by a lack of skilled medics. There is one doctor for every 50,000 people which is 10 times below the recommended World Health Organization (WHO) threshold of 5,000 people per doctor.
Nevertheless, there are over 5,000 unemployed yet fully trained healthcare workers who the government is reluctant to employ following a recruitment ban due to escalating wage bills provided for in its agreement with the International Monetary Fund.
Furthermore, Malawi has been placed on the “red list” radar by WHO due to its fragile healthcare system and has also been restricted from allowing the unemployed healthcare workers to work outside the country. WHO has identified 55 countries including Malawi that lack sufficient healthcare workers to achieve the UN Sustainable Development Goal of Universal Health Coverage by 2030.
“Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems do not have enough and many are losing their health workers to international migration,” said WHO Director-General, Tedros Adhanom Ghebreyesus, in a statement.
However, the WHO position has been contradicted by some health care experts.
“Every year, the number of unemployed doctors, nurses, pharmacists, physiotherapists, laboratory technologists and scientists, and others continues to swell,” noted Professor Adamson Muula of the Kamuzu University of Health Sciences adding that most of the trained healthcare workers live in the country but the Malawi government would not have the money to pay their salaries if they were employed in the public sector.
Secretary for the Ministry of Health, Samson Mndolo, said that the government regrets the situation noting that “the country may not be able to adequately provide Essential Health Package to its citizens and therefore miss the ultimate goal of attaining Universal Health Coverage”.
Faced with natural disasters and epidemics, Malawi’s healthcare system can barely cope with the flow of patients. Cyclone Freddy hit the country badly last March as heavy rainfall caused unprecedented mudslides and rockfalls. Although no specific statistics are available, various reports indicate that many healthcare facilities were destroyed with photographic evidence of hospitals filled with debris, mud and massive rocks. As the cyclone affected over 500,000 people in Malawi, the already weak healthcare system in some of the worst hit regions struggled to cope with the situation. The cholera epidemic that followed shortly afterwards forced the healthcare system to try to achieve the impossible by fighting this scourge which has affected about 50,000 people and claimed almost 2,000 lives.