Experiences Establishment of NPHI in Malawi Emory. Atlanta. November 2011 Benson Chilima, PhD Acting Director of Preventive Health Services Ministry of.

Experiences Establishment of NPHI in Malawi

Emory. Atlanta. November 2011

Benson Chilima, PhDActing Director of Preventive Health Services

Ministry of HealthMalawi

Malawi population: 14 million

Shares borders with: Zambia; Mozambique; Tanzania

Language1.English2.Chichewa (also spoken in the 3 neighboring countries)3.Others

Good road network

The Warm Heart of Africa

Working environment

Politics: Multi-party parliamentary democracy. Interaction between government and communities is cordial.

Basic fact1.85% live in very rural, hard to reach areas (>5 km or 3 miles from nearest health facility).

2.Nevertheless, Ministry of Health has placed Health Surveillance Assistants in all villages.

HSAHealth facility

District Hospital

Central Hospital

MOH HQ

Households

Government Executive: Cabinet of Ministers (Minister of Health)

Secretary for Health (“Permanent Secretary”)

Directorates / Departments

Service providers (In public sector all services are free of charge)

4 Tertiary Hospitals

28 District Hospitals

Health Facilities

Village Clinics

Community Health Sciences Unit, CHSU

CHAM & Private sector

Photo: Govt headquarters on Capital Hill, Lilongwe

Government structure for health

Other units

Funding mechanism for health sector is by way of Sector Wide Approach (SWAp)

1. Basket pool funding.2. Discrete funding.

Planning mechanism is by all pool and discrete SWAp funding partners together

1. Program of work (POW 2004 – 2011)2. Health Sector Strategic Plan (HSSP 2011 – 2016)

Others 1. Howard University2. Civil society 3. NGOs4. Etc.

Training institution1. College of Medicine2. College of Nursing.3. Collge of Agriculture4. Chancellor College 5. Polytechnic6. Lilongwe School for

Health Sciences

Research institutions1. University of North Carolina2. Baylor College3. Johns Hopkins University4. Malaria Alert Center5. Lighthouse6. London Sch of Hyg & Trop

Medicine (Karonga Prevention Study)

7. Liverpool University (Wellcome Trust)

8. DREAM Project (Italian)9. DIGNITAS International

LIST OF HEALTH SWAp PARTNERS (Part 1)

Others1. WHO2. UNICEF3. World Bank4. African Union5. Japan (JICA etc.)6. Save the Children7. Action Aid8. TB Care9. Sector line ministries10.Several others

USG partners1. US Embassy2. USAID3. CDC4. PEPFAR5. Many others

Europe partners1. Norwegian2. German3. GAVI (Nordic countries)4. DFID (United Kingdom)5. Republic of Ireland6. Canadian7. Several others

LIST OF HEALTH SWAp PARTNERS (Part 2)

These provide mostly technical and financial support to health

1989, Malawi Government established institutions to respond to growing challenges in health sector

Ministry of Education, University of Malawi1.College of Nursing, Lilongwe2.College of Medicine, Blantyre

“Training of doctors, nurses and other health professionals”

Ministry of HealthCommunity Health Sciences Unit, Lilongwe1.National disease control programs2.Public health reference laboratory3.Disease surveillance (Epidemiology)

2011: All SWAp partners have endorsed National Public Health Institute. (Re: Health Sector Strategic Plan 2011 – 2016). The ideal

location is the Community Health Sciences Unit. Public Health Laboratories

National EPI Vaccine Warehouse

National TB Control Program complex

Disease Surveillance Unit (Epidemiology Unit)

Malaria & Other Disease Control Programs

HIV & AIDS Unit complex

Photo: Community Health Sciences Unit in Lilongwe. October 2011

Reason for Malawi to desire NPHI1.National Center of Excellence. This is in line with …..

• 2009 meeting of Ministers of Health and AIDS in SADC Region of Africa.

• Malawi Science and Technology Act of Parliament (2003).

2.Key to further progress in elevation of health status of Malawians is in development of evidence based health policies and programs through research and development, promotion of active disease surveillance, disease prevention and control, outbreak investigations, training etc.

[Anticipated] Key functions1.Carry on existing functions:

• National disease control programs (TB, Malaria, Schistosomiasis etc)• Public health reference laboratories• Epidemiology Unit

2.Promote and implement national health sciences research agenda, monitor and coordinate research, and conduct research as necessary according to the national priority areas.

Timeline & Milestones

2007 - 2009The NPHI concept has been discussed since 2007. Little progress was made due to major changes in political leadership. . . .but the ministry persisted and we are gaining momentum.

2010A Task Force was established with members from MOH, University of Malawi and others. The first concept paper was endorsed by MOH Senior Management in July.

2011Following intensive lobbying by MOH, the NPHI has been endorsed by all SWAp partners and now is incorporated into the national Health Sector Strategic Plan 2011 – 2016.

Opportunities (high potential)1. Strong political will.

2. Sector wide approach (SWAp) – all health partners contribute to it.

3. SWAp = > Health Sector Strategic Plan recognises NPHI.

4. Malawi Government, University of Malawi and development partners already collaborate in various health projects.

5. Robust health research fraternity, with south-south and north south collaborations already in place.

6. High technical capacity exists within Malawi .

7. National Health Sciences Research Strengthening Initiative exists

8. National health agenda has been set.

9. Malawians are currently being trained abroad to specialize (MSc; PhD).

10. Well funded disease control programs, with long history.

11. NPHI concept paper has been drawn (and commented by IANPHI).

1. Report to SH & senior management• Lessons from training sessions and site visits (CDC etc).• Recommendations from Malawi team to MOH.

2. Situation analysis3. Update concept paper

• “NPHI must transform public health practice in Malawi”

4. Road map

5. Stakeholder meeting – buy in, consensus, pledges!

WAY FORWARD

THANK YOUFor listening