Malawi: Since 2006, Malawi has managed to reduce the number of HIV and AIDS related deaths from 10 to 1 person every minute, reports Terence Malamulo, a project assistant, and Asako Hamano, a student intern from Japan, in a recent article for the UNV Malawi Field Unit newsletter.
 
Citing the 2010 cumulative data reports for the HIV Department of Malawi’s Ministry of Health, they noted that efforts to reduce the number of HIV and AIDS related deaths has been especially successful over the preceding four years, when there was a 10 per cent decline in early mortality.  

In certain areas, community based organizations have empowered patients to adhere to a well balanced diet through local production of paw-paw, kholowa (sweet potato leaves) and malambe (baobab fruits) juices. These nutrition supplement initiatives along with the introduction of the medicine cotramoxizen to the antiretroviral therapy (ART) package have also contributed to the reduction of HIV and AIDS related deaths.

In 2006, Malawi had 141 sites delivering ART covering only about 17 per cent of the population in need of ART.  In 2010, 58 per cent were being reached through 396 ART-sites.  The increase in outreach ART-sites has made it easier for patients to get therapy and has resulted in improved adherence to the therapy and fewer treatment 'drop-outs'.

There are still challenges posed by frequent shortages or misplacements of HIV/AIDS test kits and ART medicines, under-resourced and under-staffed health facilities, and the stigma and cultural issues surrounding this disease.  Women still hide their HIV positive status from their husbands for fear of being abandoned, men refuse to be tested or accompany their wives for treatment and more public awareness and education on the implications of HIV/AIDS are still needed.

The retention rate of registered ART patients is currently at 73 per cent, 12 per cent less than the acceptable rate set by the World Health Organization (WHO).  
The involvement of the UNV doctors as supervisors in the project has contributed to progress in combating deaths related to HIV and AIDS.
 
"We have been playing a critical role in improving and strengthening the programme through providing high level problem-solving and decision-making, case review, quality improvement and continuing professional education through an on-going personal relationship with the staff providing services at ART, PMTCT (Preventing Mother To Child Transmission), TB-HIV and STI clinics," said UN Volunteer Dr. Mubiala Ekwala Nicodeme, HIV Supervisor for Malawi’s Northern Zone.
 
The doctors have worked at managerial and clinical level as medical consultants on administering ART treatment in all the five zones across the country. In the past two years they teamed up with health partners to facilitate a strategy on early treatment. Early start of ART helps people affected to boost their immunity system and increases chances of survival.

The Ministry of Health is initiating a scale up strategy of integrating PMTCT, ART and Tuberculosis (TB) in all ART sites in a quality and cost effective health package for all its sites. It further plans a more decentralized and harmonized approach in supervision and monitoring at zone and district level for the same reason.

According to UN Volunteer Dr. Prosper Lutala, HIV Supervisor for the Central-East Zone, Malawi in significantly reducing chronic illness and death attributed to HIV and AIDS, Malawi is working towards achieving several Millennium Development Goals  (MDGs). "Certainly the HIV programme has contributed to progress in MDGs 1, 4 and 5 and even is having an impact in others," says Dr. Lutala.  

"This translates to patients becoming more productive economically, which leads to poverty reduction, increased food production, improved health and reduction in maternal and child mortalities,”  says UN Volunteer Dr. Suleman Toranke Ibrahim, HIV Supervisor for the Central West Zone. “Parents live longer to support their siblings in acquiring the basic education they deserve."

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