Up until 1991 the was no medical college in Malawi, and there is still only one. It has gradually grown from a program with an intake of 10-15 students per year and a handful of Malawian faculty, to a program with a medical student intake of on average 60 per year with 110 faculty members, of whom approximately 67% are Malawians. To date the college has graduated over 250 medical doctors. However it is said that there are more Malawian doctors in the UK than in Malawi and who can blame them given the poor pay and working conditions- the well known brain drain!
There is still no post graduate training in Malawi for a lot of specialties and none for O&G although there is talk of this starting soon. Currently doctors have to go to South Africa for their training further reducing the work force.
Clinical officers play a key role in the health services of many African countries. They can perform 60-80% of doctors’ tasks but are faster (3years) and less expensive to train. Ammalife has looked at Six non-randomised controlled studies (16 018 women) and evaluated the effectiveness of clinical officers carrying out caesarean section. Meta-analysis found no significant differences between the clinical officers and doctors for maternal death (odds ratio 1.46, 95% confidence interval 0.78 to 2.75; P=0.24) or for perinatal death (1.31, 0.87 to 1.95; P=0.19). Warwick University is currently working to train the clinical officers in Malawi and improve their training program long term as they carry out most of the clinical work particularly in the districts.
Malawi has one of the worst doctor to patient ratios in the world.
Maternal mortality is still among the highest in Africa - 71% of women are delivered by skilled
workers. The 2010 EmONC Assessment showed that only 2% of all the BEmONC sites and about 48% of the CEmONC sites are fully functional. Obstetric complications contribute significantly to maternal deaths and bleeding alone accounts for 40% of all deaths. Other indirect causes include delays in seeking care, poor referral system, and lack of appropriate drugs, equipment and staff capacity- Maternal Mortality Rate is 675 per 100 000 (WHO 2010)
It is an exciting time in Malawi at the moment for maternal health with the new president making it a priority with her safe motherhood campaign- she has said that the goverment is determined that no mother should die while giving birth and of pregnancy complications.
lets hope she keeps does not lose focus and that his is a start of great things- President Joyce Banda we wish you luck :)
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