1. The control of a number of diseases such as Malaria still poses a big threat to health and lack of resources for indoor residual spraying and environmental control in high prevalence areas contributes to continuing health problems impacting on families, communities and the economy.
2. A recent midterm review of the HSSP showed that skewed funding in favour of some diseases results in underfunding in other areas such as Acute respiratory infections and diarrhoea. The influence of other sectors in these areas which have high morbidity and mortality is significant such as water and sanitation and pollution from wood and charcoal burning stoves.
3. Approximately 20% of the population do not live within 8 km of a facility that provides the minimum package of services free. Service level agreements signed with CHAM facilities have closed some gaps (mostly for mother and child health) however a number of problems primarily insufficient funding affects the viability of this initiative and many vulnerable communities still do not access health services
4. Under the Decentralization, the District Hospitals are funded through the District Assemblies. Funds are pooled under one operating account and this has an impact on the Health budget to the extent that mismatch of priorities has negatively impacted on day to day operations at District Hospitals. Almost all district hospitals have faced challenges in paying for utility bills including food for patients.
5. Lack of coordination of partners and other stakeholders : A resource mapping exercise was carried out and showed a large number of resources coming into the sector that are uncoordinated and often with high administration costs and overburdening health workers with parallel reporting and funding mechanisms .
6. Shortage of essential drugs and medical supplies in our health facilities is a challenge. A quantification conducted earlier this financial year showed a massive gap in funding for essential medicines. This was characterized by low funding and delayed onset of second phase of the DFID drug procurement programme.
7. Drug management in the health facilities is a challenge resulting in reported cases of drug pilferage.
8. Procurement and Maintenance of Medical Equipment and devices was also seriously hampered by low budget provision.
9. The Ministry has shortage of personnel at technical level of all cadres such as Doctors, Nurses, Pharmacists, Laboratory Technicians, Medical Engineers. These capacity gaps are being addressed by recruiting graduates from the College of Medicine, Kamuzu College of Nursing, CHAM training institutions and other recognized institutions in Malawi such as Mzuzu University. The Health Service Commission is in place and this is assisting the Ministry to fill the existing vacancies through recruitment and promotions. The Ministry has embarked on a Functional Review and this will help to increase and upgrade the posts in our health facilities.
10. Deployment of staff to hard to reach areas also remains a challenge.
11. Inadequate funds to pay for accommodation for Medical Doctors results in frequent evictions of Medical Doctors. Rents are paid by Ministry of Lands and in some cases Ministry of Health to avoid evictions. The issue of accommodation for medical Doctors requires a Policy Review by Government.
12. Dilapidated hospital infrastructure and buildings resulting from low funding also remains a challenge.
1. Improve Human resource capacity.
2. The Ministry is looking into alternative sources of finances for health among which are implementation of user fees at Central Hospitals, as a way of cost sharing considering that free services for all is not sustainable. It is further discussing with cooperating partners on continued support to the Ministry.
3. Improve infrastructure maintenance in Central Hospitals and District Hospitals.
4. Procure specialized equipment and reduce cases being referred abroad for treatment for instance Radiotherapy and other types of specialized treatment.
5. The Health Budget needs to be increased substantially to cater for overheads, maintenance of infrastructure, equipment and drugs.