Since access to health care is closely linked to the wealth of a nation, it is unsurprising that African countries have the lowest ratio of doctors per head of population. Of countries in Africa, Malawi is the worst off. According to the World Health Organisation (WHO), there is only one doctor for every 50,000 of Malawi’s inhabitants. In a country of 15 million people, that means fewer than 300 qualified doctors. Many Malawi-born doctors leave the country to practice elsewhere. The situation isn’t much better for nurses. The WHO estimates there are fewer than 4,000 nurses in the country, with a job vacancy rate for nurses running at around 65%.
Malawi can ill afford such a dearth in trained medical staff. According to data (2007) from the WHO, the average healthy life expectancy (the average number of years a person lives in ‘good health’) in Malawi is only 44 years. And the country has the 9th highest prevalence of HIV in the world, with 12% of its adult population (15-49 years) infected.
To make some progress towards improving medical services, Non-Governmental Organisations (NGOs) such as Management Sciences for Health, have recognised that supplementary medical assistants can help plug some of the gap left by the lack of qualified professionals. Malawi’s health assistants were first introduced in the 1960s as part of a programme to eradicate smallpox. Now their training is being strengthened with the assistance of the NGO to broaden their medical skills and enable these assistants to treat cases in isolated, rural communities.
In 2008, 1,000 health surveillance assistants (HSAs) were given a basic medical training course over many weeks, which included modules on diseases such as malaria, pneumonia and diarrhoea. Some HSAs then gain further training when paired with health assistants who have completed a three-year course and stand in for doctors.
Having gained this additional experience, the HSAs are sent out to remote communities where medical services have in the past been unavailable. A spokesman from Management Sciences for Health said that this approach allows many more cases of malnutrition to be identified, since often families are unable to travel with their children to the nearest hospital. The mobility of the health workers also allows for an expansion of HIV services and the wider distribution of anti-retroviral drugs. Adults who are too poorly to travel can be given supplies of these life-saving drugs.
Malawi has a high population growth rate of 2.7% per year, so the strain on medical services will only become greater in the future. Since the country is unlikely to solve its shortage of qualified medical professionals in the short term, schemes like the training of health assistants provide a realistic and tangible way of helping to address the urgent medical needs of Malawi’s people.