In 2010, Malawi experienced its worst outbreak of measles since 1997: 105,000 cases and 251 deaths were reported. Between April and August our teams helped authorities deal with the outbreak, conducting a vaccination campaign in nine districts among 3.3 million children aged between six months and 15 years. Our teams also supported the treatment of nearly 23,000 people for measles in 15 districts across the country, with a particular focus on the hard-hit southern region. The response to the emergency involved almost 1,800 Médecins Sans Frontières staff.

Malawi has an ambitious HIV/AIDS treatment plan, but it continues to face a severe shortage of healthcare professionals. A lack of international donor commitments to implement the treatment plan makes the fight against HIV a mammoth task. In 2009 more than 920,000 people (11 per cent of people aged between 15 and 49 years) were estimated to be infected with HIV, while the country had an average of only two doctors per 100,000 inhabitants. By the end of 2010, more than 345,000 people had been enrolled in the national antiretroviral (ARV) treatment programme, representing an estimated 63 per cent of patients requiring ARV treatment.

HIV/AIDS treatment

In 2003, Médecins Sans Frontières started providing ARV treatment to people with HIV in Malawi and its programmes soon evolved to include the prevention of mother-to-child transmission, the detection of treatment failure, and the provision of paediatric HIV care. We are also assisting the Ministry of Health in instituting the provision of decentralised healthcare for HIV and tuberculosis (TB) from district-level hospitals to community clinics and rural health posts.

Since 2007, Médecins Sans Frontières has helped local health authorities achieve and maintain universal access to ARV treatment for people living in Thyolo district, in southern Malawi. (Universal access is defined as the provision of treatment to at least 80 per cent of patients in need.) This was accomplished through a combination of decentralisation of services, task shifting from doctors to nurses, and the simplification of testing and treatment protocols.  As of December 2010 more than 29,000 patients in Thyolo had started ARV treatment through Ministry of Health facilities, with support from Médecins Sans Frontières.

In the neighbouring district of Chiradzulu Médecins Sans Frontières supports HIV programmes in 11 health centres, offering testing, holding consultations, supplying medicines, and providing dedicated TB treatment services. By the end of 2010 more than 18,000 people living with HIV in Chiradzulu were receiving ARV treatment, with some 650 new patients starting the programme each month.

Dealing with healthcare staff shortages

In Malawi’s rural areas, where few health personnel choose to work, needs for medical care are huge. Between 2006 and 2009 Médecins Sans Frontières established new approaches to providing HIV care. Teams transferred skills from doctors to nurses and simplified treatment guidelines to help improve the provision of care closer to home. To meet the challenges of retaining skilled health personnel in rural areas, we have also implemented scholarships for students in healthcare training programmes and hosted health worker retention conferences. In collaboration with the Ministry of Health, Médecins Sans Frontières has contributed to several other non-financial incentives and motivation strategies.

Impact of international HIV funding retreat

Despite having ambitious HIV treatment programme guidelines in line with new World Health Organization recommendations, implementation of these plans will be delayed or staged according to available resources. Malawi did not receive much-needed money from the Global Fund’s most recent round of funding, which ended in December 2010. Dwindling funding commitments point to a growing disconnect between the international community’s bold and ambitious visions for achieving global health goals, and its inability to fully support such recommendations.

Médecins Sans Frontières has worked in Malawi since 1986.