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Health Donor Group’s Speech

2014/15 Mid-Year Review «Building a Resilient Public Health

System»

On behalf of the HDG: Head of Cooperation, Mr. Bjarne Garden,

Norwegian Embassy

It is a great honour and privilege to stand before you today on

behalf of the Health Donor Group. We would like to commend all

of you who are working in the various health facilities, in the

districts and at the central level for the work that is done and for

what you have achieved to improve the health of all Malawians.

This has been a challenging year, after “Cashgate” led to a

redirection of resources from donors, and the Ebola threat and its

preparedness as well as the flood emergency that placed

additional burdens on already stretched resources in the sector.

We are now entering a phase with an increasing focus globally on

social determents of health and to ensure health in all policies.

Multi- sector work for health is challenging. Likewise, a task ahead

is to incorporate the upcoming Post 2015 agenda and the

Sustainable Development Goals.

This last year, Malawi has taken stock of achievements towards the

MDGs. Not all goals will be reached. However, Malawi has

reported on many and impressive achievements. The 2014

Millennium Development Goals Report shows the maternal

mortality ratio has gone down from 1120 per 100 000 in 2000 to 574

per 100 0000 in 2014, that the infant mortality nearly has been

halved in the same period. Malaria is still one of the major causes

of mortality and morbidity. It is therefore encouraging to see that

there has been an increase of the number of pregnant women

that receives preventive treatment and that the number of

children under five that sleeps under an insecticide-treated nets is

also on the rise.

Last years’ report from UNICEF indicated that there had been a

decrease in measles vaccination coverage. This has now been

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turned around and Malawi has exceeded its goal of 85% children

under 5 to be fully immunized. Measles vaccination coverage has

now reached 91%. This is a result to be proud of.

It is important to maintain the gains, and “walk the next mile” to

reach our common goals. When looking into the future, what are

the areas where the work should continue with the same strength

as before, where do we need to make an extra effort?

We have achieved so much in reducing under five mortality and

reached that MDG goal that was set for 2015. However, the

reduction in mortality of children during the first few days or weeks

of life is slow. We need to invest resources and partnership on

quality of care at facility level. and follow up community visits to

address the neonatal death. More people are able to live with

HIV/AIDS than ever before, much because of the increased

access to care and treatment. In Malawi, more than 50% have

access to the treatment they need. As a result of this there is a

steady decrease of newly infected persons, and prevalence has

decreased to 10,3%. However, this is still too high and we need to

target our investments and programs smartly. We know that young

people, especially girls, are at highest risk for HIV/AIDS. Women

account for 52% of newly infected HIV cases, and the majority are

young women between 15-24 years.

We also know that far too many children are stunted, and that

their learning abilities therefore may be compromised. Malawi also

have a very high number of young girls getting pregnant and

leaving school without finishing their basic education. How can we

best team up with education to ensure that information on

important issues such as reproductive health and nutrition are

covered in a good way? How can we ensure that teachers are

equipped to give appropriate and correct information? Further

investments in preventive health services make sense not only from

a health perspective, but also from an economic point of view.

Malawi has a health strategy which has guided us towards the

priority areas. This strategy will soon be replaced and updated.

Additionally, the government has also initiated a reform process to

make service delivery more accessible and with improved quality

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and results. For that you need qualified personnel on all levels

working in their field of expertise.

We are happy to see that this review has set aside time to discuss

the reforms in the health sector. A broad consultative process will

ensure that a wide range of inputs are given to the design phase

of the reforms.

How can the insurance scheme function and suggested fees work

optimally without creating and or/strengthening inequalities and

gaps in access in the system? How do we ensure that the most

vulnerable are not left behind? Will the scheme really lead to more

resources to the system? How can the MOH ensure that district

health systems are empowered adequately through the

decentralization process, enabling them to deliver comprehensive

health services efficiently and effectively?

Some of the suggestions connected to the reforms will be

controversial. Ultimately, political choices will have to be made.

For some of the elements of reform it may be wise to hurry slowly to

ensure that informed and evidence based choices are made.

Likewise, it will be important to listen carefully to signals coming

from districts and facilities. We therefore trust that this review is a

start of a longer line of consultations.

Cashgate made most donors redirect their support. This lead to

further fragmentation of support to the sector. We would like to

commend the Minister of Health for taking the leadership in better

coordination of support to the sector. The process of developing a

common funding mechanism and a common oversight has

started. We hope that this work can lead to better coordination

and alignment of support among donors and with the MoH’s own

resources. As donors, we see this as a good step forward to ensure

higher confidence in the system, and we are willing to support the

MoH in this effort and to continue the work to develop new ways

of working together.

It is also key that the Government continues to ensure that

resources are used as intended; that health workers receiving

salaries indeed show up at work, that the leakage of drugs and

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other commodities is halted and that misuse of funds have

consequences for those involved. The facilities that manage their

funding and other resources well should be rewarded. And that

those that have stolen resources from the people in need of health

services are brought to justice.

So, at the same time as we welcome GoM’s efforts to increase

budgets for essential medicines and support ongoing reforms at

the Central Medical Store Trust, the donor community is

concerned with the slow pace of reform at CMST and condemn

theft of medicines at health facilities. The theft of medicines from

public facilities has far reaching implications on the delivery of

health care services to the general population, including the most

vulnerable – like mothers and children.

With the increase in population and the ensuing strain on

resources, professional management of available resources is

crucial.

An important part of the Public Service Reform will be to ensure

that decision-making and responsibilities are placed at the right

level. Placing responsibilities at lower levels in principle should

make districts and facilities able to faster raise to challenges and

ensure that they have a stronger interest in good management of

the resources. If health workers feel that stopping leakage and

misuse of funds and resources at their workplace is not their

responsibilities, change will not happen.

We also need to look to the future. Where are the current gaps

and what is changing? Apart from areas mentioned earlier, we

know that non communicable diseases are on the rise and

account for the majority of patient consultancies. Mental health is

another area that needs much more attention. However, NCDs

and mental health do not seem to receive the attention/priority

they deserve as emerging major public health issues in Malawi.

How can the Ministry of Health meet this challenge? We also

continue to advocate for more funding to procurement of

medicines and equipment.

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In conclusion, when we discuss issues such as health sector reform,

and all the administrative and bureaucratic challenges

connected to reforms, let us not forget that we are discussing

priorities for the future as it develops.

We look forward to engage in the coming discussions on priorities

for the health sector in Malawi, and continue to be your partners

for the good health of all the people of Malawi.

Thank you. Zikomo kwambiri.