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

Malawi population: 14 million Shares borders with: Zambia; Mozambique; Tanzania Language 1.English 2.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 fact 1.85% 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. HSA Health 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 University 2.Civil society 3.NGOs 4.Etc. Training institution 1.College of Medicine 2.College of Nursing. 3.Collge of Agriculture 4.Chancellor College 5.Polytechnic 6.Lilongwe School for Health Sciences Research institutions 1.University of North Carolina 2.Baylor College 3.Johns Hopkins University 4.Malaria Alert Center 5.Lighthouse 6.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)

Others 1.WHO 2.UNICEF 3.World Bank 4.African Union 5.Japan (JICA etc.) 6.Save the Children 7.Action Aid 8.TB Care 9.Sector line ministries 10.Several others USG partners 1.US Embassy 2.USAID 3.CDC 4.PEPFAR 5.Many others Europe partners 1.Norwegian 2.German 3.GAVI (Nordic countries) 4.DFID (United Kingdom) 5.Republic of Ireland 6.Canadian 7.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 Malawi 1.College of Nursing, Lilongwe 2.College of Medicine, Blantyre “Training of doctors, nurses and other health professionals” Ministry of Health Community Health Sciences Unit, Lilongwe 1.National disease control programs 2.Public health reference laboratory 3.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 NPHI 1.National Center of Excellence. This is in line with … 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 functions 1.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 The NPHI concept has been discussed since Little progress was made due to major changes in political leadership....but the ministry persisted and we are gaining momentum A 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 Following 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 analysis 3.Update concept paper “NPHI must transform public health practice in Malawi” 4.Road map 5.Stakeholder meeting – buy in, consensus, pledges! WAY FORWARD

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