The establishment of a diplomatic relationship between Malawi and China in 2007 has seen China provide medical training of doctors, nurses, and health managers, sending medical teams from China and offering different specialist clinical services to hospital patients.
China’s commitment to the Malawian health sector seems to be borne out in practice. Barely six months into the diplomatic relationship, China began sending its medical teams, comprising a minimum of eight persons, to Malawi and has been doing so every two years. The doctors are deployed to Kamuzu Central Hospital (KCH), a referral hospital located in the country’s capital Lilongwe and Mzuzu Central Hospital (MCH), a referral facility in the northern region.
Former Minister of Health Atupele Muluzi praised China-Malawi cooperation last year, saying that it has significantly benefited Malawi.
China has been one of the first countries to support Malawi with measures aimed at preventing the spread of the novel coronavirus by donating medical equipment and other protective materials like disposable medical and surgical masks, sets of protective suits and goggles, pairs of gloves and thermometers. At the time of writing this article the number of confirmed positive cases in Malawi was 547 with 6 deaths.
When Malawi and China embarked on a relationship, the health system of Malawi, with a growing population of 17.6 million, needed a new lease of life with not enough drugs, poor health infrastructure, shortage of staff and poorly functioning medical equipment. The annual budget allocation to health is less than the amount African countries agreed to in 2001 when they undertook to increase health budgets by 15% annually.
Malawi’s health sector has been receiving a lot of international donor support.
Dr. Titus Divala, an epidemiologist at the University of Malawi’s College of Medicine in Blantyre and one of the doctors leading the fight against the coronavirus, says the pandemic has worsened the health sector’s financial problems. A quarter of the health sector budget has now been diverted to fighting the coronavirus, he says.
In January 2019 China donated state of the art equipment to both Kamuzu Central Hospital and Mzuzu Central Hospital worth MK72.2 million (US$95,000), including diagnostic equipment previously unavailable in the country. They also provided training to staff members should any equipment get broken, so that they can easily repair them.
Kamuzu Central Hospital Director, Jonathan Ngoma, has said that the Chinese support to the health system has helped a lot.
The Chinese Ambassador to Malawi Liu Hongyang said last year that China was committed to supporting Malawi’s health sector as part of its continued cooperation between the two countries. He said the Chinese medical doctors have so far treated about 58,765 outpatients, 84,844 inpatients, and have conducted 22,368 operations at both KCH and MCH.
The Chinese are also providing free medical treatment twice a year in villages where there are no doctors and clinics, with outcomes regarded as positive by the Malawian Ministry of Health.
Establishment of More Medical Facilities to Ease Congestion
China has since 2007 been very involved in infrastructure development in Malawi but has not yet undertaken the construction of any large-scale health facilities.
Some health experts argue that health infrastructure should have been the first priority of Chinese aid, instead of the national soccer stadium or hotels.
“This country does not have enough health facilities. In most rural areas patients travel long distances of about 10km or more to access health services. This is not good for sick people,” George Jobe, executive director of the Malawi Health Equity Network (MHEN) points out.
He says in most cases referral hospitals are too congested because patients come from afar and are all referred to one health center. Construction of more health facilities would help reduce that congestion.
“Through this cooperation my expectation was that the Chinese government would improve infrastructure [construction of more health facilities] to reduce congestion at our existing health facilities. A shortage of hospitals is one of the problems this country is facing. It will be better if we could have more specialist centers such as a brain surgery center,” he says.
In response to this recognized need, in 2018 China promised to construct a state of the art health facility in Blantyre which has not yet started. When built, it should go far to alleviate hospital congestion.
In his recent budget speech the Minister of Finance Joseph Mwanamveka has indicated that MKMK8.4 billion (US$11.2 million) would go towards the construction of hospitals.
Training is Necessary
China has also been sending Malawians to study medicine in China.
Ambassador Liu last year confirmed that China would continue training Malawians both here and in China in a number of sectors including health and agriculture.
“The initiative to send our young students to China to study medicine was a welcome development and really helped us as a nation,” says George Jobe, who feels that there is a need to train more health personnel.
Minister Mwanamveka recently presented his MK2.1 trillion (US$2.8 billion) budget for the 2020/2021 financial year but did not say how much would be for training health workers. MK8 billion (US$10.7 million) will go towards the recruitment of health workers.
Ten percent of the national budget goes to the Ministry of Health, which explains the need for a cooperating partner to fill this training gap.
Theft Within the System
Apart from the medical teams, equipment and training, the Chinese government has also been sending drugs to help public health facilities.
A police report of 2015 found that 35% of private clinics were selling drugs stolen from the government’s health system. Of that, 19% of the artemisinin-based combination therapy, an anti-malaria drug, sold in those private clinics were donated by The Global Fund.
In 2016 The Global Fund reported that a third of Malawi’s medicines stored at its public health facilities were being stolen each year.
The Ministry of Health Chief Director Charles Mwansambo has admitted that the country’s health sector was prone to drug theft but he was quick to point out that the government was putting in place measures like advanced drug storage units and a police anti-drug theft unit.
George Jobe of the Malawi Health Equity Network, however, doesn’t believe that those measures have worked as drug theft is still on the increase. He says that donated drugs “even today are still being stolen”.
He suggests that one of the things that the government and donors including the Chinese could do is to work together and find a lasting solution to the stealing of drugs. The sector needs a proper monitoring system of health personnel in charge of the drugs and other health supplies, he proposes, especially from the time when they arrive at the country’s medical stores.
Need to strengthen digital tracking
Franklin Kilembe, a medical doctor with his own private clinic in Lilongwe says government must install CCTV cameras around the storage facilities.
“I can assure you that even today people are still going out selling government drugs most of which are donations. The people who have access to these drugs are those taking care of them. But how do we get hold of these people? Plant CCTV cameras and then you will find and prosecute them,” he said.
He says coronavirus has attracted extra funding from many donors for PPEs and drugs and it must be protected.
Jobe agrees with Kilembe, “While we all agree that a patient’s privacy must be respected, but planting some CCTV cameras will be able to show who is doing what with the collected drugs from the stores. We also need to strengthen our online system that will help to track the movement of the drugs and other supplies.”
He also suggests that all health supplies including drugs “must have some markings which will make it easy to identify them when it is stolen.”
The China-Malawi diplomatic relationship has come at a time when the country’s health system was facing yawning deficits to such an extent that even getting a simple drug such as Panadol was considered a miracle.
It is now up to both China and Malawi to see to it that efforts continue to effectively address the sector’s ongoing problems.
Raphael Mweninguwe is a freelance journalist with over 15 years of journalism experience. He holds a Diploma in Printing Engineering Technology from The Malawi Polytechnic, a postgraduate Certificate in Media Studies from the University of Oslo, and an MA in Diplomacy and International Relations from Africa University of Diplomacy, Counseling and International Relations.