Monday, 23 November 2009

Primary Health Care (PHC): Fantasy or reality for Malawi

From the recent political blog, I am back to my senses after sobering up and ready to report on more community work. Today I am writing about Primary health Care, PHC in short.

There is a long definition of what PHC is supposed to be as given by World health Organisation: (WHO, Alma Ata Declaration. WHO1978 p.3-4) that includes 5 sets of principles, viz: affordable and sustainable health systems development, appropriate(user friendly) technology, intersectoral collaboration, community participation ,and equity to access of services –whatever these mean!!! “Remember the Health for all by the year 2000” this was one of the WHO initiatives that was going to use PHC.
Heard about Millennium development goals (MDG’s) - most of these need PHC to be achieved.
So why is an eye doctor in the forefront talking about PHC? Well, for your information we are supposed to be integrating primary eye care (PEC) into Primary Health Care (PHC).There is now renewed call by “WHO” for implementing PHC in developing countries.

But how are countries like Malawi doing on PHC at grassroots level? This is a political question so need to be answered by politicians; but I will only be giving my views based on my experiences with the communities mainly in Southern region of Malawi. For this blog I will concentrate on my experiences during my recent visit to Mangochi district.
Fact 1 : Health Surveillance Assistants (HSA’s) are the main provider of primary health care in all communities in Malawi .I was introduced to this group of workers in 2007 when I started my research in eye care and since then I have interview over 200 HAS’s and trained about the same number on primary eye care. They fall under two levels of employment by the Government; those employed before 2007 –referred as normal HSA’s and those after July 2007,referred as the Global HSAs’s (because they were deployed under the global fight against HIV/AIDS initiative).They all are supposed to undergo a 10 week orientation training in everything (preventive ,curative and rehabilitative services) and then attend other on-job trainings .
Fact 2: At most 50% of all HSA’s recruited in 2007 have not after 2 years formally attended their 10 week training in Mangochi, Zomba and Mulanje and are actively doing their day to jobs without training .
Are we sure these personnel are doing what we intended them to be doing? Are they doing standardised procedures?
Fact 3: Some of the health centres with a catchment area of higher than 10,000 persons have no medical assistants, or nurses and are left to be taken care by HSA’s who attend to and treat all sorts of patients including maternity patients . I witnessed this in Mangochi at a health centre I visited to screen blind children , I was told there was neither a nurse or medical assistant there ,the senior HSA was in charge and was doing all the clinical work (and he was staying in a beautiful institutional house that would have been used by the nurse of she were there)
Can these HSA’s treat patients even if they were trained for 10 weeks? Is this what PHC is for Malawi –HSA’s taking place of medical personnel?
For once they are not recognised and registered by any nursing or medical body in Malawi ,yet they are doing what they are not supposed to be doing .Is this what PHC is all about ?
In my view one cannot be qualified to offer medical treatment when they are only high school (secondary) leavers and have only attended 10 weeks orientation.
Fact 4 : the Maternal mortality (number of mothers dying in child birth) for Malawi is the highest in the world ; the same non trained HSA’s are supposed to be in the forefront in preventing these deaths.
Are you surprised therefore that the numbers of mothers dying is not reducing in Malawi (unless we start cooking up the figures so that they shrink)?
These HSA’s are underpaid, have poor skills and are not clinically supervised. They can only be motivated to do best by improving these?
PHC is supposed to be strengthened at grass root /community level; this is definitely not the case in Mangochi. I visited some health posts and health centres in Mangochi where they had not had any supervisory visits from the district hospital since the start of this year. In another busy health centre, I found an intern (trainee medical assistant ) running the hospital after being posted there 8 months ago; he told me he had never been supervised or told what he should exactly do.
Unless our leaders invest wisely in PHC in Malawi; we are doomed to fail.

Remember “Failing to plan is planning to fail”

Those who believe and say that we are achieving a lot through PHC should go and spend time in the communities and witness what is happening there; we may be making some progress , but some of us have collected figures that prove the contrary .Show me your statistics ,and I will show you mine. I was very optimistic about PHC when I started my research, now I have become pessimistic.
Do you more data from me?
Do you want to debate?
Or do you want just to comment?

What do you say?
Email me!
Check for my next blog? Which MDG’s can be achieved by 2015 in Malawi?

Sunday, 15 November 2009

Poor Malawi, My beloved country!!!

I have not been able to blog for the past few weeks due to pressure of work and travelling , and indeed I am overwhelmed with the current assignment I have been undertaking on behalf of Sight Savers International; Malawi office .
We are conducting a blindness survey in the South West Zone of Malawi (Thyolo, Blantyre, Chirazulu, Mwanza, Neno, Chikwawa and Nsanje) and because my teams and I have been staying in the field it has been impossible to have time to sit down and write a blog.
But the recent developments in politics in Malawi and the future implication on technical persons like myself have made me find time to blog while I am here in Thyolo ,the Muhlako was Alomwe headquarters ,and the chosen home of current rulers of my beloved country (the president ,army leaders ,police, immigration , senior lawyers and doctors .
Apart from wishing a colleague from the Muhlako “best wishes” as he has been appointed to be the “Presidents physician” (and he deserves it) and has now moved to State house , I had to bid farewell during the past weeks to the colleagues classmate (my colleague too) who was a senior physician and lecturer in Medicine at the College of medicine ,in Blantyre and has migrated to Canada last week , partly because of the racial comments that are being brought foreward by the big man.
As I sit and examine these poor patients from Ndata farm, Thyolo ,I wish to say that I have never looked at them as being from the East ,West ,South,or Central Malawi , but as Malawians who need services of a community eye specialist. But now I am being told am wrong – I need to have in my mind views of where people come from before I give them a service and if they come from a particular clan or area ,I am entitled to give them a substandard service. Well for the last 14 years as a medical officer, I have never benefited people of my own clan (despite coming from there) and have never looked at it as an issue. Already another senior colleague who is Dean of Medical colleague has indicated that he is planning to migrate from Malawi sooner than later ; and has told me that people do not appreciate my effort and services in the South because I come from a particular area of the country. I do not doubt this anymore since the big man himself has indicated that unless you are from Mhako wa Alomwe clan ,you are unlikely to be promoted or appointed to senior positions in Government . It is not surprising then that despite there being many senior vacancies in Ministry of Health; some of us have not moved an inch for the last 7 years just because we are told we were born of the wrong clan.
So , one of these days when you here that I am no longer in Malawi , do not be surprised as I will just be following what other colleagues from such wrong clans are already doing .After all ,why be patriotic of your country if you are going to be castigated by the same leaders that you vote into power .
My earlier blog indicated that I may be interested in politics in future , but for now since I have realized how dirty politics is ; I am going to stick to helping blind children in the community –and will stay in the Muhlako ; despite the big boss (President) saying that I will not be considered for any promotion because of where I come from .
And if you do not know what has been happening in Malawi recently in terms of politics and nepotism, I refer you to the websites like Nyasa times
Please do not quote any of the items in this blog as “they may result in me and my family being exiled” .
Meanwhile I remain in the Muhlako wa Alomwe area (Thyolo) for a few more weeks while I examine blind people despite being aware of comments people are making about me.
Should the president be interfering with lives of technical people like myself and threatening to kick us out of Malawi?
What do you say?
Email me!