Malawi Mid-Year Review 2014-2015 An overview of the Health Sector

1. Health Sector Mid Year Review
Crossroads Hotel
27 April 2015
Dr. Charles Mwansambo
Chief of Health Services

2. Outline
 Highlights for the Period
 Health Sector Financing
 Health Systems Performance
 Performance of Health Service Delivery
 Health Sector Reforms

3. Highlights of the Period
 In the period of July – December, 2014 the
Ministry continued to prioritize Maternal,
Neonatal, and Child health.
 There were three major emergencies:
Responding to Floods, Controlling the spread of
Cholera and Mitigating the threat of Ebola
 The Ministry pursued a number of Health Sector
Reforms to improve on the quality and
efficiency of health service delivery.

4. Health Sector Financing
 Resource Mapping Round Three showed
that MK278.8 billion is available for the
2014/15 Fiscal Year.
 MK71.8 billion (26%) comes from the MOH
Pool, MK56 billion (20%) from NAC and
MK151 billion (54%) are Discrete Project
resources.

5. Health Sector Financing
 Government contributed MK65.8 billion
(92%) of the required MK71.8 billion SWAp
Pool resources.
 The balance of MK6 billion was
predominantly contributed by the
Norwegian and Flemish Governments.

6. Health Systems Performance
 Health Systems Performance covers:
 Human Resources for Health,
 Health Infrastructure,
 Medical Equipment, and
 Drugs and Medical Supplies.

7. Human Resources for Health
 MoH Continued with Implementation of
integrated Human Resources Management
Information System (iHRIS) to improve on
data quality.
 Improved overall vacancy rate with a drop
from 47% to 45% through recruitment of 207
nurse midwives, 15 medical doctors, and 80
medical assistants – out of 534 graduates in
the period.
 Spent MK574,798,100 on 1,006 pre-service
students.

8. Drugs and Medical Supplies
 Sustained availability of essential medicines
and medical supplies.
 DfID has supported CMST with the
outsourcing of Warehousing and Distribution
to Imperial Health Sciences.
 Drug quantification for 2014/15 FY was
completed ($69 Million is needed for health
commodities).

9. Essential Equipment
 The Ministry of Health released the Service
Provision Assessment (SPA) Report which
shows availability of equipment as in the
graph below:

10. Infrastructure Development
PROGRESS OF SELECTED PROJECTS:
Project Name Status
Umoyo Houses: 140
new staff houses
and 5 flats
Progress at 60% and 50%, against
targets of 60% and 30%, respectively
Central Hospital
Rehabilitation
Progress at 70% (QECH), 0% (ZCH), 80%
(KCH), 38% (MCH)
Nkhatabay District
Hospital
Progress at 97%
Phalombe District
Hospital
Consultant recruited, Contractor
recruitment in progress
15 Health Centers Progress at 15%, against target of 30%

11. Health Service Delivery
Performance
HOSPITAL ATTENDANCE, ADMISSIONS AND DEATHS:
Districts Central
Hospitals
Total
OPD
attendances
5,024,404 364,572 5,388,976
Admissions 258,615 81,474 340,089
Inpatient
deaths
5,639 3,468 9,107

12. Maternal Health
 10.5% of pregnant women visiting ANC in their
first trimester against target of 17% (HMIS)
 87% deliveries with skilled birth attendant (2014
MDG Survey)
 90% of births occurred spontaneously, 6.8% (C-
section), 1.7% (Breech, vaginal), 1.4% (vacuum
extraction) (HMIS)

13. Child Health
0
10
20
30
40
50
60
70
80
90
100
Fully Immunized Measles Pentavalent 3
Percentage(TargetvsCurrent)
Current Target
PROPORTION OF CHILDREN IMMUNIZED AT DISTRICT LEVEL

14. Malaria
MoH released the 2014 Malaria Indicator Survey report
Indicator 2012 MIS 2014 MIS
% of those suffering from malaria who have
access to and are able to use collect,
affordable and appropriate treatment within
24 hours of onset of symptoms
24 31.2
% of pregnant women who have access to
and receive two or more doses of IPTp for
malaria prevention
55 63
% of children under 5 years of age sleep
under an ITN
56 67
% of pregnant women sleep under an ITN 51 62
% of outpatient suspected malaria cases who
are confirmed by parasitological diagnosis
65 75

15. Diarrheal Diseases
 212,538 diarrheal diseases, representing an
Incidence Rate of 165 per 1,000 in under-fives
 15% of diarrhea cases reported in Lilongwe, 8%
in Blantyre, and 5% in Mangochi

16. Health Sector Reforms
(More details in Session 2)
Activities include:
1. Reviewing the
Partnership with
CHAM
2. Establishing a Health
Fund
3. Revitalization of
Health Insurance
Schemes
4. Reforming Hospital
Operations, including
Decentralisation

17. Thank You for Your Attention
QUESTIONS?

18. ANNEXES – ADDITIONAL SLIDES

19. Health Sector Financing
• Only MK8.1 billion of the projected MK24.6
billion discrete resources were disbursed as at 31
Dec 2014
Discrete Donor
2014/15
Expected
Disbursements
(MK)
Disbursement
for Mid Year
(MK)
% Disbursed as at 31st
December 2014 (MK)
Norway/FICA 5,202,003,261 4,205,743,959 81%
UNHCR 87,729,027 36,564,234 42%
Global Fund
(GF) 17,468,327,200 2,704,228,664 15%
CDC 1,867,095,646 1,148,144,102 61%
Total 24,625,155,134 8,094,680,959 33%

20. Human Resources for Health
• Promoted 524 staff to different
positions in the reporting period of
which 249 were Medical Assistants to
Senior Medical Ass.
• Conducted promotional interviews as
follows:
–1,350 HSAs to Senior HSAs
–Fresh employees to fill 1, 350 vacant
positions to be created.

21. Human Resources for Health
• 5 Radiotherapists and 2 Medical
Engineers sent to school under the
Cancer Capacity Building Project.
• Obtained Establishment Warrant (EW)
from the OPC to create 47 positions for
laboratory technologists (90% of
technologists who have graduated from
different schools to be absorbed).

22. Essential Equipment
• Status of Procuring Selected Equipment :
Equipment Type Status Cost Center
Mammography
Machines
Delivered, awaiting
installation
Central Hospitals
Radiography
Machines
In progress, advanced
stage
KCH, MCH, QECH
X-Ray Machine, Tube In progress Salima, Karonga
thermos-
luminescent
dosimeter reader
Donated by IAEA KCH
5 Standby
Generators
In Progress, 1 Delivered
to Mchinji District
Hospital
District Hospitals
2 Oxygen Plants In progress KCH, QECH

23. Malaria
• Continued trend in reduction of Malaria
Incidence Rates
396
456
484
371
332 332
223
0
100
200
300
400
500
600
June, 2009 June, 2010 June, 2011 June, 2012 June, 2013 June, 2014 Dec, 2014
IncidenceRate
Period