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Coping with Competing Priorities: TB/HIV in Malawi

Learn about the devastating impact of HIV/AIDS on Malawi's public sector and the strategies to address the challenges. Presentation discusses the intersection of TB and HIV and the National HIV/AIDS response in Malawi.

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Coping with Competing Priorities: TB/HIV in Malawi

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  1. NAC: HOW TO COPE WITH COMPETING AND NUMEROUS PRIORITIES: WHERE DOES TB/HIV FIT? By Dr.Biziwick Mwale Presentation at the 2nd Global TB/HIV Working Group Meeting Durban, South Africa 14th to 16th June 2002

  2. MALAWI DEMOGRAPHIC AND HEALTH OVERVIEW • Land locked country located in Southern Africa • Eleventh poorest country (Human Development Report 2000) • Population 9.8 million with 1.9% growth rate (1998 census) • Poor health indicators

  3. HIV/AIDS Situation in Malawi • HIV/AIDS has reached devastating proportions in Malawi • Prevalence 15% among adults 15-49 years of age • One million Malawians are living with HIV • About 500,000 have died since the start of the epidemic • Has created 500,000 Orphans

  4. HIV/AIDS Situation in Malawi • On average 25% of urban and 13% of the rural population are HIV positive • HIV/AIDS mostly affecting young productive Malawians aged 15-49 years • Projections indicate that a minimum of 25% and as much as 50% of the people currently employed in the Urban based sectors will have died of AIDS by 2005

  5. HIV/AIDS AND TB • Upsurge of TB since 1985 • Annual reported TB cases 1985 5,000 TB cases 2001 27,000 TB cases • Largely due to HIV • Over 60% of the TB patients are HIV positive • TB common opportunistic infection in HIV patients

  6. IMPACT OF HIV/AIDS IN MALAWI • Malawi is loosing key professionals in all sectors • The public sector is one of the affected sectors

  7. THE HIV/AIDS IMPACT STUDY ON THE PUBLIC SECTOR IN MALAWI • In 2001 government with financial and technical support from UNDP Conducted an HIV/AIDS impact study in the public sector • The aim of the study was to asses the impact of HIV/AIDS on human capital development, supply and productivity in the public sector • Assumption was that a significant proportions of the deaths in the public sector have been related to HIV/AIDS

  8. THE HIV/AIDS IMPACT STUDY ON THE PUBLIC SECTOR IN MALAWI • Key findings: • High employee attrition • Death is the leading cause of attrition followed by retirements and resignations respectively. • Most deaths are due to AIDS related illnesses • High mortality rates are noted mainly among frontline staff and professionals

  9. THE HIV/AIDS IMPACT STUDY ON THE PUBLIC SECTOR IN MALAWI • Female employees die at an earlier age than the Male employees • High vacancies largely due to employee attrition • High government costs for training, funerals and payment of premature terminal benefits • Reduced public sector productivity

  10. IMPACTS OF HIV/AIDS IN MALAWI • Increased morbidity • Increased mortality • Increase in orphans • Resurgence of tuberculosis (TB) • Reduction of life expectancy • Reduced productivity in all sectors

  11. MULTSECTORAL NATIONAL HIV/AIDS RESPONSE • In 1999, Malawi developed the National HIV/AIDS Strategic Framework (2000 – 2004) • The Framework was costed at US$160 million over 5 years • At the March 2000 resource mobilisation roundtable conference – about US$110 million was pledged

  12. MULTSECTORAL HIV/AIDS RESPONSE • Funding gap estimated at US$50 million • Most of this money was already programmed money

  13. RESTRUCTURE OF THE NACP TO NAC Government decided to restructure the NACP because: • NACP link with the MOHP • NACP was a biomedical implementation arm of MOHP • NACP was more involved in implementation than coordination • High staff turn over- Government structure

  14. THE NATIONAL AIDS COMMISSION (NAC) • Established in July 2001 • Largely through restructuring the NACP • Has a board of 19 Commissioners representing the public sector, private sector and the civil society • The chairperson of the NAC reports to the Cabinet Committee on HIV/AIDS and Health through the Minister of Health and Population

  15. ROLE OF THE NATIONAL AIDS COMMISSION Coordination of the multsectoral HIV/AIDS response • Resource mobilization • Technical support • Policy development and interpretation • Research • Monitoring and evaluation

  16. CHALLANGES • NAC is a new institution with very high expectations • How to coordinate the various partners with different funding flow channels (consultancy on coordination underway) • How to achieve national coverage (importance of the SWAP or basket funding) • Absence of an HIV/AIDS Unit within the Ministry of Health and Population

  17. CHALLANGES • Greater reliance on donor funding for the implementation of the National HIV/AIDS Strategic Framework (Budget line for HIV/AIDS created for each ministry in the 2002/2003 fiscal year) • Weak district Assemblies (Decentralisation underway). • Absence of full time District AIDS Coordinators

  18. CHALLANGES • Monitoring inflow of the pledged resources with different funding channels(Data base created) • How much of the pledged resources have come into Malawi (Review of resource flows under way) • To what extent has the National HIV/AIDS Strategic Framework been implemented (review of the implementation of the strategic framework under way)

  19. CHALLENGES Need to define and agree on: • The role of the NAC Secretariat • The role of the Board of Commissioners • The role of the Ministry of Health and Population • The role of the Donors • The role of the Minister of Health and Population • The role of the Cabinet Committee on HIV/AIDS and Health

  20. COLLABORATION BETWEEN TB/HIV • Resurgence of tuberculosis (TB) since 1985 • Strong link between HIV and TB • Over 60% of the TB patients are HIV positive • Steady increase of PTB and EPTB • High case fatality in TB patients is a result of the strong link with HIV

  21. COLLABORATION BETWEEN TB/HIV • The risk of developing TB or getting recurrent TB is increased in HIV positive people • TB is largely treatable

  22. WHERE DOES TB/HIV FIT? • The ProTEST project has catalysed collaboration between TB and HIV • Both programmes are now working together including developing joint implementation plans • At district level, the ProTEST Project has brought together key HIV/TB stakeholders in joint programme planning and implementation

  23. WHERE DOES TB/HIV FIT? • There is a focal point for HIV/TB in each of the two programmes • There is an active TB/IV Technical Working Group • The two programmes have developed a joint three year HIV/TB implementation plan.

  24. CHALLANGES • Whether the TB and HIV programmes should remain distinct programmes or should be integrated particularly at District level • How to integrate and scale up the ProTEST project to all districts with the current limited resources in the MOHP • Absence of an HIV/AIDS unit within the Ministry of Health and Population

  25. CHALLANGES • Government support to create the necessary staff positions to integrate the programme • Absence of full time District AIDS Coordinators • Availability of resources for HIV/TB activities to sustain the current level of the programme (Hope for the GFATM, MAP and CDC support)

  26. THANK YOU FOR YOUR ATTENTION

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