Health Donor Groups 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 MoHs 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 GoMs 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.

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.