Spotlight Malawi: Many Paths Towards Universal Health Coverage and a Strong Health Workforce

Bomani, a 13-year-old villager in Malawi, has always had a passion for soccer. But he doesn’t aspire to be a professional soccer player. “I want to help people,” he says simply. “I want to be a policeman.”

His father says Bomani helps his family by drawing water and being a good student – each requiring a 60-minute roundtrip journey on foot. When someone in Bomani’s family is sick, they ride the family bicycle to the nearest clinic. When asked how far they must ride, they laugh and answer: “Very far.”

Over 80% of the population lives in rural and remote areas, where walking many miles is a daily requirement. Health centers are few and far between; only an estimated nine percent have adequate staff. In the rainy season, travel is often impossible. For the severely ill villager referred to the Queen Elizabeth Central Hospital in Blantyre, the barriers to reaching treatment are daunting.

Despite the country’s notable progress in improving individual health outcomes, maternal, newborn, and child mortality remain high, and Malawi’s HIV prevalence is one of the world’s highest.^[1] Skilled health workers are in great need, as are training, medical tools, and supplies. The World Health Organization states that countries need at least 4.45 skilled health workers per 1,000 people to achieve Universal Health Coverage (UHC),^[2] but Malawi has only 0.019 physicians and 0.283 nurses and midwives. For a population of more than 18 million people, there are fewer than 600 physicians.^[3]

UHC is achieved when everyone can access health care without suffering financial hardship. This is only possible with a sufficient capacity of qualified health workers. For more than a decade, Takeda’s global health and corporate social responsibility (CSR) initiatives have been contributing to UHC through long-term commitments to disease prevention, capacity building — including health worker training— and access to healthcare. Every year, Takeda’s employees vote to select the activities the Company supports as the Global CSR Program , including partnerships with Seed Global Health, World Vision, and other NGOs and international organizations who are addressing the shortage of skilled health care professionals in sub-Saharan Africa and elsewhere.

Empowering health workers…with water
While visiting Malawi in October 2019, Takeda employees discovered there are many paths toward UHC and building up the skilled health workforce. Water, as it turns out, is one of them.

“The public water supply sometimes cuts off halfway through the day, so we’re building a back-up water tank so that midwives always have a reliable source of clean water, because births happen 24/7,”explains Katherine Beach, a Seed Global Health midwife educator currently working with Malawian colleagues at Queen Elizabeth Central Hospital to create a midwife-led maternity ward for low-risk births.

One medical school for a population of 18.5 million
There is no dedicated teaching hospital for the students in Malawi’s only medical school, or for students who attend one of the 18 nursing training schools. Students must typically go abroad to further their medical training, which public health salaries cannot support. But that is changing. Thanks to organizations like Seed Global Health, the current cohort of family medicine doctors at the University of Malawi’s College of Medicine is the first that will have been trained domestically.

“With the money that I spend on sending one student to South Africa, I could train three people locally,” said College of Medicine Principal Dr. Mwapatsa Mipando. Being able to train more students at home reduces costs, addresses the health worker shortage, and will improve care for Malawi’s population.

A positive future ahead
In 2019, Malawi’s Parliament approved the College of Medicine’s proposal to transition to an independent university of health sciences with a dedicated teaching hospital, making medical training much more accessible for Malawians.