<< Programmes - HIV/AIDS

Providing Better Healthcare:

UNV Doctors

Location:
District hospitals and Central hospitals
Period:
2004 - 2011
Corporate Thematic Area:
HIV/AIDS, Capacity Development (as a cross-cutting theme)
2007 Budget:
US$ 1,500,000
Implementing Partners:
Ministry of Health, United Nations Volunteer Programme
Development Partners:
Ministry of Health, Global funds through NAC
Contact:
Halima Chande
Programme Officer
P.O. Box 30135
Lilongwe 3, Malawi
Office: +265 (0) 1 773 500, Ext. 223
halima.chande@undp.org

2 doctors and 28 nurses to every 100,000 Malawians

There is a critical shortage of doctors in Malawi. Vacancy rates in critical healthcare positions are very high—in 2004, 68 percent of doctors, 58 percent of nurses and 32 percent of clinician positions remained unfilled. This understaffed health care system must manage a number of pressing health problems. National prevalence of HIV is 14 percent for the age group 15-49, which is particularly alarming as this is the economically productive group. The fertility rate is very high at six births per woman and many are not attended by skilled health personnel. Maternal mortality is also very high (roughly two percent of live births). Other problems include malaria, tuberculosis, and poor nutrition. Life expectancy is only 46 years.

Until 2007 Malawi College of Medicine has graduated on average 20 doctors per year. Of these, poor pay drives many to accept higher paid jobs outside of Malawi or choose to work in private health facilities. The medical college has expanded its programme by 300 percent and 2008 will be the first year graduating a larger class of 60.

The Government of Malawi and the UN system are both committed to improving capacity in the public health system. The Malawi Growth and Development Strategy, for instance, specifically targets improving the doctor to population ratio. UNDP aims to improve national capacity to deliver services, particularly to vulnerable groups. Managing and monitoring the response to HIV and AIDS is a high priority. Considering the severe shortage of doctors, reinforcing the district and central hospitals by placing UNV doctors there is an important step in this direction in the framework of the six-year Emergency Human Resource Plan under the Health Sector Wide Approach.

The programme has been scaled up in the last three years from nine to over 45 doctors based on its successes. One of the main values of UNV Doctors in Malawi is to alleviate the burden placed on the Malawian healthcare system. With few or no doctors in place, UNV doctors are filling major gaps, which is a full-time job. However, to promote sustainability the doctors are also active in training, mentoring and knowledge tranfer. They give presentations, trainings and daily on the job demonstrations for clinical officers, medical interns and nurses. UNV Doctors are seconded to district and central hospitals around the country and are in some cases the only qualified doctors in the hospital except for the District Health Officer whose main task is management rather than clinical work. Currently there are 14 medical specialists—in surgery, obstetrics and gynaecology, internal medicine and orthopaedics; four antiretroviral treatment (ART) supervisors and 21 general practitioners in the programme and it is envisaged to grow throughout 2008.

Reducing Mortality of Road Traffic Accidents
Malawi has a poor record with road traffic safety—at Kamuzu Central hospital between 60-80 percent of the surgical cases coming in per day are from road traffic accidents. These accidents tend to be fatal, particularly because of poor management of patients before they arrive to the central hospital.

The UNV surgeon, Dr. Madinda, placed at Kamuzu Central Hospital since 2004 has conducted trauma training for hospital staff as well as for staff at six of the eight district hospitals. As a result patients now increasingly arrive in stable condition. Mortality due to trauma has decreased by an estimated 40-50 percent since Dr. Madinda’s arrival in 2004.

There is an ART supervisor based at each of the central hospitals. They each work with 30-50 health centres and clinics in their zones and provide supervision and mentoring to health personnel in administering ART.

Training Health Care Workers on treating HIV/AIDS in Zomba
Dr. Bizuwork is the ART supervisor at Zomba Hospital. He spends perhaps 80 percent of his time treating patients—both in the field and at the hospital. In this capacity, Dr. Bizuwork travels throughout the district, consulting on treatment for complex patients. He has also provided training to 100 healthcare workers and 50 home-based care volunteers at village level and to graduating nurses as well as giving refresher courses for existing practitioners. Dr. Bizuwork aims to build a network of people to expand ART care available in Zomba district.

There are also 21 general practitioners posted in the district hospitals.

The UNV Doctors programme has been effective in importing qualified doctors to address a serious skill shortage. While the Ministry of Health has found the programme valuable enough to direct its Global Fund resources to pay future UNV Doctor salaries, a main challenge faced by UNV Doctors is to develop capacity rather than to just supplement it. The presence of UNV Doctors assures a basic supply of doctors to public hospitals. However, the limitations of the programme are manifold as it neither addresses shortcomings in equipment and drugs nor the level of pay for Malawian Health personnel.