Comparison of the situation before and during corona pandemic in Malawi

The country before the Corona pandemic

Since Malawi is a country that depend a lot on tourism, people come to Malawi to visit, work and do business in various departments. These visitors pay fees and in terms VISA. Because of this VISA contribution, this helps the country to have foreign currency. That helps it to compete on the international market and it enables the country to buy materials and resources from other countries without problems.

Health System

Health services in Malawi are provided by public, private for profit (PFP) and private not for profit (PNFP) sectors. The public sector includes all health facilities under the Ministry of Health (MOH), district, town and city councils, Ministry of Defence, Ministry of Internal Affairs and Public Security (Police and Prisons) and the Ministry of Natural Resources, Energy and Mining (Ministry of Health, 2008b). Public provision of health care is enshrined in the republican constitution which states that the State is obliged "to provide adequate health care, commensurate with the health needs of Malawian society and international standards of health care" (Ministry of Justice, 2006).

Health services in the public sector are free-of-charge at the point of use. The PFP sector consists of private hospitals, clinics, laboratories and pharmacies. Traditional healers are also prominent and would be classified as PFP. The PNFP sector comprises of religious institutions, non-governmental organisations (NGOs), statutory corporations and companies. The major religious provider is the Christian Health Association of Malawi (CHAM) which provides approximately 29% of all health services in Malawi (MSPA 2014). Most private and private-not-for-profit providers charge user fees for their services. Table 1 shows the distribution of health facilities by type and ownership.

Malawi's health system is organized at four levels namely: community, primary, secondary and tertiary. These different levels are linked to each other through an established referral system. Community, Primary and Secondary level care falls under district councils. The District Health Officer (DHO) is the head of the district health care system and reports to the District Commissioner (DC) who is the Controlling Officer of public institutions at district level.

Community level

At community level, health services are provided by health surveillance assistants (HSAs), health posts, dispensaries, and maternity clinics. Eash HSA is meant to be responsible for a catchment area of 1,000 and there are currently 7,932 HSAs supported by 1,282 Senior HSAs in post. HSAs mainly provide promotive and preventive health care through door-to-door visitations, village and outreach clinics and mobile clinics (Ministry of Health, 2011).

Primary level

At primary level, health services are provided by health centres and community hospitals. Health centres offer outpatient and maternity services and are meant to serve a population of 10,000. Community hospitals are larger than health centres. They offer outpatient and inpatient services and conduct minor procedures. Their bed capacity can reach up to 250 beds (Ministry of Health, 2011).

Secondary level

The secondary level of care consists of district hospitals and CHAM hospitals of equivalent capacity. Based on Table 6 in the HSSPII, secondary level health care facilities account for 9.5% of all health care facilities. They provide referral services to health centres and community hospitals and also provide their surrounding populations with both outpatient and inpatient services.

Tertiary level

The tertiary level consists of central hospitals. They ideally provide specialist health services at regional level and also provide referral services to district hospitals within their region. In practice, however, around 70% of the services they provide are either primary or secondary services due to lack of a gate-keeping system (Ministry of Health, 2011).

Ministry of Health headquarters

The functions of the central level include policy making, standards setting, quality assurance, strategic planning, resource mobilization, technical support, monitoring and evaluation and international representation. Five Zonal Quality Management Offices (QMOs) are an extension of the central level and provide technical support to districts.

District Health Offices

The functions of the district health offices (DHOs) include: managing all public health facilities at district level and directing provision of both primary and secondary level health services at district level. DHOs report to District Commissioners who are under Ministry of Local Government. At technical level, DHOs receive technical backstopping from Zonal Quality Management Office (QMDs) who are under the Ministry of Health.

Coverage

MoH policy is that every Malawian should reside within an 8km radius of a health facility. The proportion of the population living within 8km radius of health facility (health centres and hospitals) stands at 90% in 2016, an increase from 81% in 2011. This indicates that there is still a proportion of the population that is underserved; especially those residing in the rural and hard to reach areas and 56% of Malawian adult women still cite distance to health facility as a key barrier to health access when they are sick.

Most of the health facility infrastructure across both Government and CHAM is dilapidated due to long periods of lack of maintenance (Ministry of Health Malawi, 2016).

The country during the pandemic

Enforcement and security

• Police and MDF deployed to provide border security patrols
• Road traffic police enforcing new seating capacity for public transportation
• Control of crowds in public and private service outlets (e.g. banks)
• Joint patrols on Lake Malawi (MDF and Immigration)
• Roadblocks mounted in strategic points across the country

Point of entry

• Monitoring personnel transporting essential goods and services
• All borders closed except 3 for essential personnel travel (e.g. petroleum services and other goods).
• Personal stories of the people
• What they expect for the future

Logistics

• Deliveries to districts of supplies from UNICEF is done
• Deliveries to districts of supplies from Chinese donation in progress - besides the districts, this alsoaccommodates Army, Prison, and Police
  

Risk communication and community engagement

• The national team deployed to northern region to strengthen district teams in community engagement and management of cases
• Continued airing of COVID-19 public service announcements on community and national radio stations.
• Daily press briefings on the evolving outbreak situation
• Daily updates through ZODIAK radio
• Set up interactive COVID-19 messages on Airtel *929#
• Production and printing of fact sheets, posters, leaflets, and roll-up banners.
• Push messages on Airtel and TNM in both English and Chichewa.
• Community awareness meetings in progress
• Develop messaging for public service announcements to suit the current measures on lockdown.
• Mobile van units for the distribution of information, education and communication materials in Lilongwe,Blantyre, and Mangochi

Coordination

• Presidential Task Force on COVID-19 was established and they meet regularly
• Weekly health cluster meetings
• Weekly meetings of technical committees for the various response pillars
• Daily surveillance technical committee meetings
• Daily emergency operation center meetings
• Implementation of the national response plan

Conclusion
The Ministry of Health and partners continue in its efforts to ensure the citizens are protected from the Coronavirus outbreak and that the country is able to detect and respond to any cases that may arise.

• Daily update dashboards can be accessed from https://covid19.health.gov.mw/
• Toll-free call line with Chipatala Cha Pa Foni (number: 54747).

Because of the lock down in almost every country in the continent this has affect Malawi a lot, because there is no opportunity to do any business such as schools, tourism, fish traders, air cargo, ship cargo, trains, cruise ships, farmers that import and export goods and services. Countries has been restricted and this has read to many businesses to be closed because a lot of companies aren't able to pay their employees since they are not making any money. For your own information, in Cape Maclear, where I stay there are about 20 Lodges and now as I write they are all closed since their businesses are not working at the moment so they are unable to provide salaries for their workers (Ndwala, 2020).

Sources