2014/15 Annual Review Report for the Health Sector
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2014/15 ANNUAL REVIEW REPORT FOR THE HEALTH SECTOR Ministry of Health, P.O Box 30377, Lilongwe 3 SEPTEMBER 2015 1 TABLE OF CONTENTS Table of Contents .............................................................................................................. 2 LIST OF Figures .................................................................................................................. 5 LIST OF TABLes .................................................................................................................. 7 ABBREVIATIONS ................................................................................................................ 8 EXECUTIVE SUMMARY .................................................................................................... 10 Chapter 1: INTRODUCTION ......................................................................................... 18 1.1 Background ....................................................................................................... 18 1.2 Methodology in Producing the Report ............................................................ 18 1.3 Outline of the Report ....................................................................................... 19 Chapter 2: HEALTH SECTOR FINANCING ..................................................................... 20 2.1 Background ....................................................................................................... 20 2.2 HSSP Financing ................................................................................................. 21 2.3 Effect of health funding on health outputs and outcomes .............................. 27 2.4 Conclusion ........................................................................................................ 28 Chapter 3: Health Systems .......................................................................................... 30 3.1. Background ....................................................................................................... 30 3.2. Human Resources for Health (HRH) ................................................................. 30 3.2.1 Overview ......................................................................................................... 30 3.2.2 Specific 2014/15 HRH Activities ..................................................................... 36 3.2.3 HRH Data Management .................................................................................. 36 3.2.4 Pre-Service and In-Service Training ................................................................ 38 3.2.5 Recruitment .............................................................................................. 40 3.2.6 Promotions ............................................................................................... 42 3.2.7 Performance management system ........................................................... 44 3.2.8 Management and leadership .................................................................... 44 3.3 Medicines and Medical Supplies ...................................................................... 45 3.3.1 Weaknesses in the procurement system ....................................................... 53 3.3.2 Drug leakage ................................................................................................... 56 3.3.3 Lack of rational consumption ......................................................................... 56 3.3.4 Increased demand for biomedicine................................................................ 57 3.3.5 Conclusion ...................................................................................................... 58 3.4 Essential Equipment ......................................................................................... 60 2 3.4.1 Donations ........................................................................................................ 64 3.5 Health Infrastructure ........................................................................................ 65 3.5.1 Construction of Staff Houses .......................................................................... 70 3.5.2 Construction of Health Centres ...................................................................... 70 3.5.3 Rehabilitation of Health Facilities ................................................................... 70 3.5.4 Construction of New District Hospitals .......................................................... 71 3.5.5 General Challenges of Health Infrastructure .................................................. 71 3.5.6 Way Forward on Health Infrastructure .......................................................... 73 3.6 Referral System ................................................................................................ 74 Chapter 4: PERFORMANCE OF disease areas ............................................................. 80 4.1 Background ....................................................................................................... 80 4.2 Service Access and Utilization in Public Facilities ............................................ 80 4.3 Hospital Attendance, Admissions and Deaths ................................................. 81 4.4 Sexual Reproductive Health and Rights (Maternal and Newborn Health) ...... 84 4.4.1 Implications of high fertility and high population growth ............................. 89 4.4.2. Progress on selected sexual and reproductive health .............................. 91 4.4.3 Direct Obstetric Deaths ............................................................................. 97 4.4.4 Antenatal services ..................................................................................... 98 4.5 Extended Program in Immunization (EPI) ...................................................... 100 4.6 Malaria ........................................................................................................... 104 4.7 Acute Respiratory infections .......................................................................... 110 4.8 Diarrheal diseases .......................................................................................... 111 4.9 Cholera ........................................................................................................... 113 4.10 Sanitation and hygiene ................................................................................... 113 4.11 Tuberculosis ................................................................................................... 114 4.12 Nutrition ......................................................................................................... 119 4.13 HIV/AIDS and Other Sexually Transmitted Infections (STIs) .......................... 124 4.13.1 Geographic Variation .................................................................................. 126 4.14 NON COMMUNICABLE DISEASES (NCD’s) ...................................................... 137 4.14.1 Palliative care Services ............................................................................... 140 4.14.2 Gender based violence ............................................................................... 141 4.14.3 Injuries as a result of road traffic incidents ................................................ 143 4.15 Neglected Tropical Diseases (NTD’s) .............................................................. 147 4.15.1 Special Lymphatic Filariasis ........................................................................ 147 3 4.15.2 Oncorceciasis .............................................................................................. 155 4.15.3 Leprosy and Skin Diseases .......................................................................... 155 4.16 Eye Health ...................................................................................................... 159 4.17 Public Health Response to Emergencies ........................................................ 160 4.17.1 Response to the Ebola Threat .................................................................... 161 4.17.2 Response to the Floods and Subsequent Cholera Threat .......................... 163 Chapter 5: HEALTH SECTOR REFORMS ..................................................................... 166 5.1 Reviewing the partnership with the Christian Health Association of Malawi (CHAM) ...................................................................................................................... 167 5.2 Establishing a Health Fund ............................................................................. 167 5.3 Revitalization of Health Insurance Schemes .................................................. 168 5.4 Reforming Hospital Operations and the District Health System ................... 168 Chapter 6: Partner Reports ....................................................................................... 170 6.1 Central Medical Stores Trust (CMST) ............................................................. 170 6.1.1 CMST Key performance indicators ............................................................... 170 6.1.2 Staffing levels and capacity building ............................................................ 174 6.2 CHAM ............................................................................................................. 176 6.2.1 Funding ......................................................................................................... 181 6.3 Nurses and Midwives Council of Malawi