Malawi is a landlocked narrow country bordered on the western side by Lake Malawi. It is the most resource-limited country in southern Africa and is the most densely populated in the whole of Africa with a fertility rate of 5.7 per female. It has the highest HIV prevalence with the national rate of 10.6% and the lowest health worker population ratio of one doctor to 88,000 people. Life expectancy is among one of the lowest in the world, is just 41 years because of HIV/AIDS, malaria and tuberculosis and lack of healthcare system.
The population of Malawi is at 15 million with 40% of the population lives below poverty level and over 85% are subsistence farmers in the rural areas. Foreign aid including IMF and the World Bank and from countries like USA, Britain and Germany constitutes about 40% of the entire government budget and pays the bills for over 90% of its investment and development projects. An economy that depends on subsistence farming and some exportable cash crops will find it difficult to be rid of foreign aid dependency.
In healthcare, donors contributed at least 60% of the expenditure during the 2006 to 2009 cycle. One of the more acute problems is the persistent shortage of healthcare workers. The country is operating on 33% of the required healthcare workers as stipulated by WHO and of those only 35% of them serve in the rural areas where 80% of the population reside. global funds provide 100% of the HIV medications.
The seroprevalence of HIV in the nation varies between 10.6 to 12% but there are regional differences with the most populated southern region where Nsanje is having a prevalence of 16 to 18% in 2010 with 65% of the newly infected being recorded there. The main mode of transmission is through heterosexual sex followed by mother-to-child transmission.
MSF has been in Malawi since 1997 with the aim to reduce the morbidity and mortality of HIV and TB and in 2003, it started treatment of HIV/AIDS and its associated infections in Thyolo. Since 2011 MSF began to be involved in Nsanje in the support of the Ministry of Health in a mentorship program in the provision of quality HIV care and also introduced targeted health system such as test and treat sero-discordant couples, sex workers, non-surgical male circumcision, treatment of all HIV positive pregnant women and integration of HIV/TB services. My main role will be in the mentorship program and to help with the integration of other services.
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