The gathering storm

The country’s population is swelling with a crippled health care system supporting it, reports EPHRAIM NYONDO.

Well, the storm is not really about a population that experts say will triple by 2050.

Rather, Malawi—against a rising a population driven by a high fertility rate at six children per woman, low uptake of contraceptives, currently at 40 percent, and reduction in mortality rates—is suffering from a huge disease burden.

This is a result of a shortage of health care workers and dwindling resources being channeled to the health sector.

Unless there is proper planning and adoption of solid measures by government and development partners to avert the debacle, the country is heading towards a storm, says Professor Chris Whitty, chief scientific adviser and director of research and evidence for the Department for International Development (DfID).

Whitty said this last week during a public lecture at Kamuzu College of Nursing (KCN) in Lilongwe organised by DfID to share information with various stakeholders regarding practical demographic and development realities that feed into policy planning.

In a presentation titled ‘Changing Global Demography and What This Means for Malawi’, Whitty, in the first place, noted that Malawi has made tremendous health strides.

Child mortality has dropped from 260 per every 1000 live births in the 1980s to around 60 to date, he noted. Maternal mortality, he added, has been reduced from 750 out of every 100 000 to 500 out of every 100 000. Whitty also showed that life expectancy has been pushed from 46 to 52 since the year 2000. HIV and Aids pandemic has gone into retreat, he explained.

However, despite these strides, Whitty noted there are serious challenges ahead for the country if nothing is done to plan ahead for the population boom which must be expected.

According to Whitty, with fertility rate—the average number of children that would be born to a woman—hovering at six, which is eighth highest in the world, it means the population will grow fast, reaching around 45 million by 2050. At the end of the century, he added, the population of Malawi is currently projected to grow over five times.

This ballooning of the population will pose a challenge to government in its development efforts making Malawi a fertile ground for poverty and disease as echoed by this year’s statement from the United Nations.

“The concentration of population growth in the poorest countries will make it harder for those governments to eradicate poverty and inequality, combat hunger and malnutrition, expand education enrolment and health systems, improve the provisions of basic services and implement other elements of a sustainable development agenda to ensure that no-one is left behind,” reads the statement.

However, according to Whitty, the swelling of Malawi’s population is both a threat and an opportunity.

“Dependency ratios will remain high for a long time; Malawi will have a young population when other countries are aging even if fertility falls fast; and population growth will be fast, making pressure on land possible but not inevitable,” he noted.

Whitty, who is a physician and also an epidemiologist, recommended that the way out for Malawi is to, among other things, bring about efficiencies in agriculture, making child health and education to be major priorities, improving availability of contraceptives, especially long-acting ones, and having political commitment and leadership to deal with the challenges ahead.

On improving the country’s health care in preparation for the gathering storm, Professor Address Malata, Principal of Kamuzu College of Nursing (KCN), outlined the challenges facing the health care system in Malawi.

“An ever increasing population, a huge disease burden of both communicable and non-communicable diseases, including injuries from rising accident numbers, low health care financing resulting into critical shortage of drugs and supplies, poor infrastructure and a health worker crisis associated with recruitment, deployment and retention of medical personnel are key challenges facing the country health sector,” noted Malata in a presentation titled ‘Challenges facing the Health Care System in Malawi and its Relation to Demography’.

He added that despite Africa having 25 percent of global burden of disease, the continent has less than five percent of the global work force servicing it and Malawi is among the countries that suffer critical shortage of health care personnel.

“The vacancy rate for nursing and midwifery positions in public sector is over 70 percent and out of 10 000 trained nurses and midwives, only 50 percent is in the clinical setting while the rest have gone into private sector or abroad in search of greener pasture,” he explained.

Malata also added research to the list of problems, citing limited research funding, and utilisation of findings to impact practice, policy and education despite health care research in Malawi having developed over the last decade.

A well experienced figure, Malata—who is a nurse and midwifery leader in education, practice and research in Malawi, Africa and globally and has the development and implementation of six masters programmes and a PhD programme at KCN credited to her name—bemoaned lack of political will, proper and adequate policies governing the health care system and leadership capacity at all levels to address crippling challenges in the health sector.

The presentations which left a cross section of participants—comprising politicians, development partners, academics, government technocrats and students—stunned as to what lies ahead for Malawi as a country, attracted varying questions from the audience.

The public lecture, according to head of office for DfID in Malawi, Jen Marshall, was the second on the series of lectures which the department has organised for information dissemination and sharing with different stakeholders. She said that regarding these pressing population challenges, the UK was helping Malawi in a number of ways.

Since 1987, DfID has been a major donor of Banja La Mtsogolo (BLM), which delivers quality reproductive and sexual health services to communities across Malawi. Through its current support to BLM of £25.2 million (around K20 billion) running from 2012 to 2016, DfID Malawi estimates that they fund approximately half of Malawi’s reproductive and sexual health services across the country.

Since 2009, DfID estimates that the programmes averted close to one million pregnancies and prevented over 2 000 maternal deaths. It has also contributed to the reduction of total fertility rate from 5.7 to five and an increase in contraceptive prevalence rate from 46 percent to 59 percent for married women.

In helping Malawi to pull through this population challenge, DfID also supports wider progress in the country that should enable a reduction in fertility levels by being a major investor in Malawi’s health services, including in improvements in infant and child health, and in Malawi’s education sector, helping girls to stay in school and delay first pregnancies. n