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?
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Check for my next blog? Which MDG’s can be achieved by 2015 in Malawi?