1 CHAPTER 1.
1.1 Introduction: Mission and Strategic Interventions of the Ministry of Health
The Ministry of Health in collaboration with its cooperating Partners have since been implementing a six year Program of Work under the framework of Sector Wide Approach. The POW identifies strategic interventions that would assist the Ministry of Health realise its Mission which is to ‘ stabilize and improve the health status of Malawians by ensuring availability of an effective health care delivery system that is capable of promoting health, preventing disease, protecting life and fostering well-being’. The major strategic intervention in the POW is to ensure access of an essential health package to all Malawians especially the rural poor and vulnerable groups such as women and children. The essential health package comprises of high impact health interventions that address disease conditions that contribute to high burden of morbidity and mortality in the population. Other strategic interventions that support delivery of the essential health package are as in Figure 1
1.2 Implementers of the Program of Work
The Ministry of health is the major implementer of the POW intervention especially delivery of the essential health package through its chain of central hospitals , district hospitals, rural and community hospitals, health centers, dispensaries and health posts. Other players in the sector who work in partnership with the Ministry include CHAM, Banja la Mtsogolo (BLM) and the private hospitals and clinics. Health Training institutions also play their part by training health workers both at pre-service and post basic level, while other members of civil society play advocacy role as well as monitoring satisfaction of beneficiaries Figure 1: Strategic Interventions of the Health program of Work
Increase availability of health workers in the public health sectorDevelopment; recruitment and retention of Human resources a amanagement of f Human Resources
Develop, review and monitor implementation of health related policies, gguidelines & standardsguidelines and standards Monitoring and Evaluation
Development and rehabilitation of health Infrastructure
Ensure access to quality essential health services
Increased availability of essential drugs and medical supplies suppliesSupply of drugs and medical supplies
Continuous availability & maintenance of medical equipmentuProvision and maintenance of equipment
Strengthening operations at district level
1.3 Financing of the Program of Work.
Financial resources for the POW are from government and cooperating partners who provide financial resources either as pool donors or discrete donors. During the reporting period, funding from some pool partners such as the World Bank and Sweden expired and has not been renewed. The Flemish Government is expected to join the pool fund in the coming financial year The Current financial resources are therefore form:
Malawi Government British Government through DFID Government of Norway Global Fund German Government (KFW & GTZ))
UNFPA UNICEF World Health Organization Iceida African Development Bank USAID
1.4 . Monitoring Implementation of the Program of Work
2 Progress of implementation of POW is monitored through a numbers of modalities which include continuous supervision by different levels of the Ministry of health; joint annual and midyear reviews, technical working group meetings, collection and analysis of data on agreed upon indicators of the POW.
CHAPTER 2: PROGRESS OF IMPLEMENTATION
o 2. 2. 1 Achievement of SWAP POW Indicators
Good progress has been observed in most of the targets set for the 2008/009 financial year. Among the achievements recorded include continued increase in EHP coverage ( (number for facilities able to deliver general OPD services; immunizations, family planning and maternity services) from 74% to85%; utilization of OPD services in health facilities from 1170 to1235 per 1000 population, proportion of one year children immunized against measles from 84% to 89%;and proportion of births attended by skilled attendance from 48% to 52% and increase in percentage ( 80 % t0 88%) of HIV pregnant women who receive complete ARP prophylaxis to reduce mother to child transmission. Little or no progress was observed in some indicators such as number of pregnant women and under-five children who slept under an ITN and number of pregnant women who start antenatal care within the first trimester. Annex1 provides details on progress made on each indicator
2.2.2 Progress on Strategic Intervention 1. Increasing Availability of Human Resources for Health
Development and management of human resources for health continues to be a priority intervention in the health sector to ensure appropriate staffing levels at all levels of health services delivery points. Activities carried out during the 2008/009 financial year included, support for pre-service and post basic
training, recruitment from training schools and the labor market, provision of incentives and in-service or continuous short term training. Implementation of these activities took into consideration recommendations and milestone agreed upon during the 2007/008 Joint Annual Review (Annex 2).
2.2.2.1. Pre-service Training
Pre-service and upgrading programs for professional health workers were given priority. All training institutions maintained their high enrollment figures, a total number of 1021 joined the various training school to train either as medical doctors medical scientists, pharmacists, nurses, clinical officers etc. Similarly the number of graduates is also on a steady increase as shown on as shown on Table 2. In addition to pre-service training, support was also given to those health workers interested in specializing or upgrading their basic qualification. The specialized courses included Masters degrees in paediatrics and internal medicine for medical doctors, masters degree in public health for clinical and non clinical personnel; midwifery for nurses and upgrading for diploma nurses and nurse technicians. Tables 1 and 2 provide details of the students enrolled for and graduating from the different training programs. As can be observed on tables 1 and 2, priority was given to training of professional health workers over management and development programs. Only 15 officers from the Finance department went for training in EPICOR in Tanzania.
Table 1: Number of Students Entering and Graduating from health training Institutions ( 2008/009 Academic year
No Category of Health Worker New Enrollment: 2008/009
Continuing Students
2008/009 Graduate
1 Medical Doctors 61 277 452 BSN 106 257 643 BMedSc ( Lab) 26 66 144 B.Pharma 20 45 05 Dip Clinical Med 91 1206 Dip RN 65 16 317 Dip NMT 452 698 3628 Cert. Clinical Med 120 281 1509 Lab Tech 20 45 3410 Pharmacy Tech 20 40 1911 Radiology Tech 20 38 2412 Dental Tech 20 15 8
Table 2. Number of Students Enrolled and Graduating from Post Basic Training Programs
No Type of Training
New Enrollment: 2008/009
Continuing students
Graduating Students
1 Master of Public Health
6 24 17
2 Mmed ( Paeds)
- - 1
3 Mmed ( Internal medicine)
- - 1
4 Mmed 8 - -5 MSN
( Midwifery) 10 - -
6 BSc ( Nursing Educ.)
29 22 26
7 Unv. Cert. Midwifery
35 - 30
8 RN upgrading 22 22 159 Psychiatry
Nursing 8 - 12
10 Community Nursing
1 5 - 15
11 MSc ( RH 2 - -12 TOTAL 135 68 11913
2.2.2.2. Short- Term Training
To assist health workers keep abreast of new knowledge and developments in health services a number of short trainings were conducted either by central or district level. Training targeted all categories of health workers as well as extension workers who support implementation of preventive health programs. Details of the trainings and the number of people trained are as in Table 3 below.
Table3: Category of Health Workers who participated in short term Trainings in 2008/2009
No Type of Training Category of Health Workers Number Trained1 HIV Testing & Counseling Clinical & Non Clinical staff 7312 HTC Supervision Clinicians 343 Update on HIV & AIDS Clinical & Nursing Educators/Tutors 254 ART & OI Management Clinicians & Nursing Personnel 4505 STI Trainers Update Clinicians 806 STI Syndromic management Clinical & Nursing Personnel 257 TOT WBRT Lab Technicians8 STI M&E tools Clinical, Nursing & Lab Techs 1109 Oncocerciasis prevention Extension workers 10,49310 Oncocerciasis mass treatment Clinical, nursing, environmental staff 2,83011 IDSR Lab personnel 140
12 ARI case management ( ETAT) Clinical & Nursing Personnel 32013 Community IMCI HSAs 47314 Food safety & Water quality
monitoringExtension workers 88
15 Professionalism & Ethics Registered Nurse- Midwives 9116 Cholera case management Mixed categories of health workers & extension
workers10,190
2.2.2.3. Recruitment and Deployment.
In addition to supporting training of professional health workers, the Ministry in collaboration with the health Service Commission conducted recruitment exercise for the public health sector. The recruitment exercise focused on students who were about to complete their training as well as those health workers who were outside the public health sector or were out of employment. Through these efforts 871 graduates were recruited and deployed to various government health facilities including CHAM. The gala exercise which focused on the open labor market identified 500 health workers comprising Clinical Officers, Nurses Medical Assistants and Environmental health Officers who will be offered employment in the coming financial year (2009/2010).
2.2.2.4. Retention and attrition of Health Workers in MOH Facilities.
Recruitment of health workers into the public health sectors need to be supported by retention strategies if the goal of increasing staffing levels is to be achieved. The incentive package which was developed and adopted last year was not implemented due to financial constraints. However two interventions which were included in the 2008/009 budget were implemented. These included continued payment of 52% salary top up for professional health workers and promotions. Most promotions were effected to fill vacancies created through the 2007/008 Functional review; through interview procedures, the Health Service Commissions recommended for promotion 171 health workers of various categories. Despite the recruitment and retention efforts, the public health sector still experiences attrition of health workers. During the period under review, 331 exited the public health sector either through death resignations and retirement. As shown on Figure 2 below, death accounted for
the highest (55%) cause of attrition followed by resignations. A few people retired from the service.
FIGURE 2: Causes of Attrition
169110
31
DeathResignationsRetirement
Due to the high numbers of attrition the net gain from the recruitment exercise is high not enough to make a significant reduction on the vacancy rate which is still high for medical doctors (58%) and 76% for nursing personnel. Figure 3 provides details on the vacancy rate for the different cadres in the Ministry of Health FIGURE 3: VACANCY RATES
Vacancy Analysis as of June, 2009
49
1522
63
86
5866
73 74 76
3242
88
00
102030405060708090
100
Admini
strati
on
Human
Resou
rce
Accou
nting
Audit
Specia
list
Doctor
s
Clinica
l
Techn
ical
Pharm
acy
Nursing
Preven
tive
Attend
ants
Plannin
g
HIV &
AID
S
Cadre
Rat
e
Vac
2.3. Strategy/ Pillar 2 – Provision of Pharmaceuticals and Medical Supplies
The target for pharmaceuticals and medical supplies in the period under review was to make sure that essential drugs, medical supplies and laboratory reagents are readily available in all facilities in the country. In order to do this the ministry allocated 15% of its total budget for procurement of drugs, medical supplies and laboratory reagents.
2.3.2. Drug Availability
Activities implemented to achieve the stated target involved among other things strengthening the logistics supply chain which included national drug quantification exercise in order to quantify national drug needs; issuance of tenders and procurement of drugs at Central Medical Stores (CMS), timely completion and submission of LMIS by DHMTs to inform CMS on monthly drug orders; timely distribution by CMS and active security measures for drugs both at CMS, RMS and service delivery points. Other activities carried out included capacity building of Zonal and District teams on monitoring drug usage, training of pharmacy technicians in LMIS and supportive supervision, production and circulation of monthly stock status report of Tracer Drugs.
Major achievement during the reporting period was reduction in stock out days for most essential drugs except for HIV test Kits. Figure 4 provides details on availability of some
tracer drugs. In addition to HIV test Kits, there are other essential items that were perpetually out of Stock at CMS. For example drug such as
Tetracyclines Sulbutanol Nebuliser Hydrocortizone injection Heppatitis vaccine Salbutanol tabletsAminophylline tablets Skin codition creams/ointments Quinine tablets Suture Umbilical cord cramp
Due to this perpetual stock out of these items DHMTs were forced to procure the items from commercial pharmaceutical stores at higher prices. This may probably be one of the reasons why DHMTS have accumulated a high debt at CMS. HIV Kits were also out of
FIGURE 4: Drug Availability by Zone
NZ
CEZ
CWZ
SEZ
SWZ
0 20 40 60 80 100 120
LA4x6LA 1x6SPTB drugsDiazepamTTVOyctocinORSH/Test Kits70
2.3.3. Interventions to improve availability of HIV Test kits
Following the wide spread stock out of HIV test kits an assessment of the HIV test kits logistics system was done which revealed systemic supply chain challenges such as1. Wide variations in the distribution of test kits across the supply chain2. Wide variations in the ordering of the test kits3. Inconsistent reporting on consumption and stock on hand4. Inconsistencies in the use of LMIS forms5. No standard system for storage and delivery of kits
To address these problems the following were recommended
1. Management of test kits to be fully integrated into MOH commodities logistics management system (MHCLMS). This is the system used for managing essential drugs and medical supplies.
2. Health Centres and HTC sites will pull test kits from RMS through their districts by completing LMIS forms and then submitting them to district pharmacy technicians.
3. Re-supply quantities will be generated by the supply chain manager (SCM), based on past month consumption.
4. RMS will be the central storage facility for HIV test kits. 5. District pharmacy and drug stores at Health Centres will be the storage facilities for Test
kits.6. High consumption sites, like MACRO and Lighthouse Trust, and other NGOs/CBOs that
do not have a pharmacy will be required to have a storage room with restricted access for storage of kits.
7. HTC counselors will be responsible for proper storage of tests in their custody in a lockable cabinet.
8. RMS will be responsible for direct delivery of kits, together with other essential drugs and health commodities to all hospitals, HCs including CHAM facilities.
9. High consumption sites will pay for and collect their kits from RMS10. NGOs/CBOs will collect from district pharmacies.
Other achievements in ensuring drug availability included:
1. Improved record keeping that has assisted in better forecasting and quantification of national drug requirement
2. Circulation of stock Status of Tracer drugs has provided opportunity for DHMTs to predict drugs available and prepare for requesting authority to procure outside CMS system
3. Quantification exercise has assisted CMS to estimate appropriate drug budget to meet national drug demand
2.3.4. Transformation of Central Medical Stores
Other interventions carried out on this strategy were efforts towards transformation of CMS from a Treasury Fund to Public trust Status. Major achievements in this area are the deregistering of CMS as Treasury Fund and the development of a Trust Deed which has been forwarded to the Minister of Justice for legal advice. Other support activities for this transformation are development of a draft organizational chart for the proposed Public Trust and the progressive recapitalization of the CMS through provision of funds necessary for establishment of letters of credit for procurement of drugs.
2.4. Strategy / Pillar 3: Continuous Availability and maintenance of Basic medical equipment
Availability of basic equipment is an essential component of health service delivery. Interventions planned during the year to ensure availability of such equipment included the following:
Standardization of equipment list for district/community hospitals and health centers Procurement of medical and hospital equipment Planned Preventive Maintenance Finalization of Standard List for medical equipment Equipment survey to determine the gap Specialist technician training in the maintenance training in dialysis machines and x-ray machines.
Implementation of these activities was however hampered during the period under review due to limited budget as out of the requested budget of MK1.1bn only MK66 million was provided for. Similarly, out of MK66 requested for operations only MK19m for operations was approved. Due to this financial handicap, only Kamuzu Central hospital received new laundry and opthamology equipment procured at MK98 million. Contracts for the supply of medical equipment for the various hospitals worth MK305m have been signed with various suppliers, and delivery is expected in the next financial year. The planned preventive maintenance of equipment in facilities was not carried out du to budgetary constraints Likewise, no spare parts were procured because of the same reason. Facilities, therefore relied on their old equipment to provide services. Most of the available equipment functioned optimally through out the year as shown on Figure 5 . However functionality of some equipment was not at 100% as shown Figures 5 and 6.
FIGURE 5: Percent of functional days for Basic Equipment
B/bank Oxy.Conc.
X-ray75
80
85
90
95
100
B/babankOX.Conce.Xray
The standard list for medical equipment for district and community hospitals, and health centres was formulated and published in March 2009 with joint funding from SWAp and JICA. .
Equipment survey was conducted to establish what equipment is available against the expected figures as prescribed by the Standard List of equipment. Currently, analysis is being carried out to determine the gap in district and community hospitals and health centres. Similar analysis for central hospitals awaits the determination of a Standard List for Central Hospitals.
FIGURE 6:Percent Functional Days for Basic
M/Cold Room
Ultra-sound
gen-erator
74767880828486889092
M/Cold RoomUltrasoundGenerator
2.5. Strategy/ Pillar 4: Development and Rehabilitation of Health Infrastructure
2.5.2. Funding for Infrastructure Activities
The 08/09 development budget was funded up to 6.8billion for both part I (6,757,970,000)
and part II (113,000,000). The targeted projects were as follows:, construction of Umoyo
staff houses, Construction of Basic Obstetric Care, expansion of training institutions,
construction of laboratories, Construction of Orthopaedic Centre at Kamuzu Central
Hospital, Rehabilitation of Zomba Central and Balaka District Hospitals, reconstruction of
Mzuzu Central Hospital sewerage, and preparatory work for the New Nkhata, Phalombe
District Hospital and Dowa District Hospitals. Apart from this budget districts and partners
had set aside funds to improve infrastructure in many facilities in the districts
2.5.3. Construction of Umoyo Staff Houses
The project aimed at improving the delivery through proper accommodation for medical
personnel. It involved the construction of new 250 houses that have been built across the
country and also rehabilitation the 250 existing staff houses. The initial plan was to construct
300 new staff houses but it was later revised considering the need for rehabilitating some
existing ones to avoid imbalances at the health facility.
The project is funded from the SWAp pool funds. The total budget for 08/09 was around
MK3.5 billion. The project has so far disbursed MK2 billion, an amount which was funded
but less than what was provided for in the budget. Currently, almost 95% of the new houses
is complete and 80% of the houses under rehabilitations are also complete. The challenge so
far is utilities connection by Electricity Supply Commission (ESCOM) and Water Boards,
which has prevented most of the houses be handed over.. The Ministry has since
communicated to the concerned authorities so as to have all connections done by end October
2009.
Completed Umoyo in NgabuRrural Hospital Chikwawa awaiting electricity
connection.
2.5.4. Construction of Basic Emergency Obstetric Care units (BEmOC)
The project aims at rehabilitating 54 health centres and make them BEmOC sites where
maternal services are being provided, provision of houses and functional utilities. The project
is being funded by a grant from the African Development Bank amounting to US$15million
(MK1.9) across the country and also includes support to the reproductive health programmes
mainly training. The Ministry has so far disbursed MK800million and is expected to
disbursed the rest before the grants expires in June 2010. The 44 BEmOC sites are expected
to be completed by October 2009 and the remaining 12 which were re-tendered due to no
proper bidders, by June 2010. Below is one of the BEmOC sites in Chisoka, Thyolo:
Chisoka BEmOC site showing part of the houses, the OPD and Martenity ward.
Expansion of Training Institutions.
With an aim of increasing intake to Health Training Institutions, the Ministry supports
Training Institutions in their Capital Investment. These are Malawi College of Medicine,
Malawi College of Health Sciences (Blantyre, Zomba and Lilongwe), Kamuzu College of
Nursing and CHAM. In 08/09, the total support was about MK888million and 09/10 is about
MK683million. Malawi College of Medicine resource centre captured below which is
expected to be completed by November 2009, is among the structures benefiting from the
pool funds.
Resource Centre at Malawi College of Medicine, Blantyre Campus.
Malawi College of Medicine Lilongwe Campus awaits the awarding of contract and is
expected to start in the 09/10 financial year. However, Malawi College of Healh Science
expansion in Lilongwe started as well as Blantyre campus for Kamuzu College of Nursing in
Kameza..
2.5.5. Laboratories Refurbishments
The project aimed at refurbishing laboratories as a way of improving diagnostic services both
at district and health centre levels. The budget provision was MK300 million. The phase one
considered the refurbishment of 7 laboratories and these included: Mangochi and Mwanza in
the southern region, Lilongwe (Bwaila), Mchinji, Kasungu in the central, and Rumphi,
Nkhata Bay in the north. Mchinji laboratory was completed and is now in use, Bwaila,
Mangochi and Mwaza are also completed and are about to be handed over. Poor
workmanship in Kasungu, Rumphi, and slow progress by the contractor in Nkhata Bay, has
had a negative effect on the completion of these laboratories. This project is overdue and has
had a very poor disbursement record. The Ministry is therefore planning to engage a
consultant who will supervise the remaining works in Kasungu, Rumpi and Nkhata Bay and
also help in supervising the 09/10 budgeted 23 laboratories refurbishment in various district
and health centre facilities.
2.5.6. Construction of Orthopaedic Centre at Kamuzu Central Hospital
The project involved the construction of an Orthopaedic Centre at Kamuzu Central Hospital.
The 08/09 provision was MK10, 500,000 and the work is completed
2.5.7. Rehabilitation of Balaka District Hospital
The project involved the construction of an administration block, paediatric ward, isolation
ward, kitchen and a VCT centre. The project aims at upgrading the hospital to be a fully
fledged District Hospital and it is being financed from the pool funds with a 08/09 budget
provision of MK40 million. This however had fallen short to the estimated scope of work
which was pegged at MK136 million. This project was expected to be completed by June 09,
however, due to late signing of the contract and the extension of the scope of work mainly for
the VCT centre, all works are expected to be completed by December 2009. The project has
so far disbursed MK119 million. However, from the revised estimates from the Ministry of
works experts, largely due to the inclusion of a VCT centre, the project is expected to cost
MK179 million.
2.5.8. Rehabilitation of Zomba Central Hospital
The project is funded under SWAp pool funds comprising of TB wards, dental clinic and
administration block (lot 1) and also staff houses (lot 2). The budget 08/09 provision was
MK548 million. Lot 1 commenced in September 2008 and is expected to be completed in
August 2011. So far, 30% of the work has been completed. The construction of houses is
expected to be completed November 2009 and is currently at 40% completion. There is also
an eye clinic under construction being funded by Lions AID Norway.
2.5.9. Preparatory work for Phalombe, Dowa and Nkhata Bay District Hospitals
The new Phalombe District Hospital project has not yet started due to lack of potential donor.
This also applies to new Dowa District Hospital. However, 2009/10 will allocated funds for
designing and the Environmental Impact Assessment as part of preparatory works. Clearing
the site for new Nkhata Bay District Hospital is finished and award of contract is expected to
be by December 2009. The hospital is expected to be completed by November 2011. The
total cost including equipment, is estimated at $10.7million.
2.5.10. Maintenance of Mzuzu Sewerage System at Mzuzu Central Hospital
The project aims at rehabilitating the Mzuzu Central Hospital sewerage. The 08/09 budget
provisions were MK12 million. The work which is being supervised by the Ministry of
Works is yet to be implemented in the 09/10. The project did not take place due to capacity
problems by the supervisors. However, with the functional Infrastructure Unit in the Ministry
which will work hand in hand with experts from Ministry of Works, the project is expected to
be completed in the 09/10 financial year. The project involves designing and building of a
new sewer system.
2.5.11. Ethel Muthalika Maternity Wing at Kamuzu Central Hospital
The project is being funded by the Clinton Hunter Foundation. Malawi Government is
however purchasing all the equipment for the wing. Actual construction is completed and all
equipment is expected to be in the country by December 2009. The maternity wing is
expected to be opened in February 2010.
2.5.12. Bwaila Maternity wing
The project has been funded by the Rose Foundation. It has a bed capacity of 140 beds and is
expected to be opened in October 2009.
2.5.13. Status of Infrastructure at District level
DHMTs are continuing with their efforts in ensuring that health centers and staff houses
meets standard norm. All districts therefore supported the national infrastructure program by
maintaining staff houses and some health centers. Rehabilitations aims at installing running
water, communication system, electricity and making any necessary renovations. Currently
55% health centers satisfy the standard norm of running water, electricity, and
communication system and being fully renovated. This is an increase of 15% from last years
figure of 40%. Progress has also been made in providing same development in existing staff
houses whereby a total of 187 out of the target 450 houses were renovated.
2. 4. 13. Transport
District health offices have a total of 470 vehicles out of which 332 are runners. Of the vehicles that are runners 190 are ambulances. Distribution of bicycle ambulances has assisted referral of maternity. Progress made by districts in the reporting period consisted of procuring vehicles using ORT budget, boarding off non runners and implementing transport management. However the overall transport management is not good at district level. Only
seven districts have some documentation. on transport management. Of those that have some information none calculates or monitors transport performance
2.6. Strategy/Pillar 5: Ensure access to quality essential health services
There has been continued progress in ensuring access to quality essential health services as a result of progress made in the other pillars especially the human resources for health. Notable progress has been the sustained coverage of EPI antigens and continued progress in making sure that eligible Malawians access ARVs. Progress made in most areas of the EHP are summarized below.
2.6.2. Prevention of Vaccine Controllable Diseases: Expanded Program of Immunization (EPI)
The EPI programme has continued to make progress in making sure that infants get fully immunized against childhood immunizable diseases before attaining the age of 12 months, all pregnant women get vaccinate with at least two doses of tetanus toxoid vaccine and women of childbearing age with 5 doses of TT.
Vaccination Clinic In Progress in Rumphi
At community level sensitisation on the importance of completing the immunization schedule and that surveillance activities for diseases of elimination and eradication remain effective
were key areas in which the programme made progress. A summary of progress in EPi is outlined in Table 4
Table4: Progress in immunization coverage
Progress Target Comment91% of EPI health facility reports were timely 95% Good84% of EPI district reports were timely 90% FairCompleteness of EPI reports was 100% 100% Very good4% of outreach under five clinics were cancelled <10% Very goodPenta 3 coverage was 95% 90% Very good86% of districts with penta 3 coverage of ≥80% 80% Good90% coverage for measles CABS indicator 80% Very good82% of districts with measles CABS indicator of ≥80% 80% GoodPenta1-Penta3 dropout rate was -0.6% (utilization of immunization services)
≤10% Very good
95% of districts with good utilization of services 80% Good94% of under one children had access to immunization services
90% Very good
96% of districts had good access to immunization services 100% GoodMeasles coverage for integrated measles campaign 100% 95% Very goodNon-polio AFP rate was 2.5 2.0 Good71% of districts had a non-polio rate of ≥2.0 100% PoorStool adequacy for AFP was 88% 80% Good79% of districts had stool adequacy of 80% 100% Fair93% of districts reported at least 1 AFP case 100% Good96% of the districts reported at least 1 measles case 100% Good
2.6.3. Acute respiratory infection
ARI programme has registered great success in the period under review despite problems in
accessing funds for programme activities. Progress made in acute respiratory infection has
been the achievement of hospital based case fatality rate for pneumonia of below 8% at the
National level with some districts such as Chitipa and Ntchisi district hospitals having
pneumonia case fatality rate of 1.4% and 2% respectively.
2.6.4. Malaria
Malaria control is one of the key Essential Health Care Package interventions in Malawi. During the period under review the malaria control program had mainly lined activities targeting case management, ITN distribution and indoor spraying. Progress made during the review period has been the mass distribution of 1.2 million ITNs to under-five children, conducting Indoor Residual Sprays at Ministry of Health, CHSU, HEU and Nkhotakota district. Other notable progress was the conducting of net retreatment campaign using 1, 2, 3 K-O tab, training of new health workers on Malaria Case Management and non increase in Malaria cases and related deaths as illustrated in the Table 5 and Figure 7 below
Table 5: Selected Indicators on Malaria Cases in Malawi, 2004/05 - 2008/09
Period
Population of
MalawiTotal Malaria New Cases
Total Malaria Inpatient Deaths
Malaria Incidence
(%)
In-patient Deaths
Per 1,000 Populatio
n
Total Malaria Cases as %
of Total OPD Attendance
2004 – 2005
12,341,170
3,481,684 6,444 28.2 0.52
35
2005 – 2006
12,757,883
4,204,468
7,216 33.0 0.57
30
2006 – 2007
13,187,632
4,442,197
6,566 33.7 0.50
35
2007 – 2008
13,630,164
5,208,241
8,558 38.2 0.63
34
2008 – 2009
13,066,340
5,781,126
8,452 44.2 0.65
34
Source: Central Monitoring & Evaluation Division (CMED)
FIGURE: 7
Selected Indicators on Malaria Cases, Malawi 2004/05 - 2008/09
28.233.0 33.7
38.2
44.2
0.52 0.57 0.50 0.63 0.65
3530
35 34 34
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
2004 - 2005 2005 - 2006 2006 - 2007 2007 - 2008 2008 - 2009Period
Malaria Incidence (%)
In-patient Deaths Per 1,000Population
Total Malaria Cases as % ofTotal OPD Attendance
2.6.5. Reproductive Health
Reproductive health unit continued to make progress in family planning, community-based maternal and newborn care services, institutionalization of condom use, skills training of service providers youth friendly health services and performance Quality Improvement (PQI.)Progress made by the unit includes:
Injectable contraceptive has now been introduced at community level in 9 districts, delivered by Health Surveillance Assistants.
A total of 437 HSAs and 18 supervisors have been trained in CMNH package. The three districts (Nkhotakota, Rumphi, Machinga) except Phalombe trained 120 HSAs on Community mobilization. Chitipa, Thyolo and Dowa trained 107, 100 and 70 HSAs on Community Mobilisation respectively.
Skills of service providers in male and female condom use and disposal were provided with updated information on the two products. From June 2008 a total of 330 service providers from all sectors were trained. (A total of 398 were trained in 2008). From January to June 2009:30 service providers from District hospitals including Likoma were trained in male and female condom use.
Training has been provided to DHOs, Deputy DHOs, DNOs, FP Coordinators and District Youth Officers (DYOs) all districts in the Southern Region namely. on Reproductive Health Commodity Security – Supply Chain.
12 participants were successfully trained and certified in repairing obstetric fistula. Refresher training was done in November 2008. Orientation of Community VHC was done in Mangochi in 2008. Orientation programme for Health care workers from Lilongwe District was conducted from 25th May -9th June 2009.
35 health workers were trained during the two sessions in VIA for the screening of cervical cancer and management of minor lesions. Refresher course took place for health workers from Ndirande, Chilomoni and other health facilities in the Southern region.
Basic Emergency Obstetric Care trainings (BEmOC) continued to be conducted through the zones with at least a minimum of one training per zone. Two supportive supervision visits were conducted to follow up on trained health workers in the health centres. Observation was that the BEmOC functions are being performed though several facilities lacked the manual vacuum aspirator for removal of products of conception in incomplete abortion and vacuum extractors.
The ten districts supported by Partnership in Maternal, Newborn and Child Health (PMNCH) implemented activities such as open days in the Community, Oientation of Traditional Birth Attendants on their new roles, integrated supervision and Community Case Management (Harmonised manual). A review meeting was conducted to share progress and best practices by the districts.
The female condom has also been integrated in a number of other programmes outside the health sector such as the Women, Girls and HIV programme under the Ministry of Women and Child Development, and the National Youth Council under the Ministry of Youth. This has increased access because more CBOs have requested training due to the demand and providing free female condoms. There are now 105 main service delivery points in the country with some having several other outlets in the community.
Malawi has now started the provision of DPMA at community level through HSAs hence guidelines and training manuals are in place.
Depo provera is now available at community level in at least 9 districts. Districts with active CBDA program show impact by increasing CPR
More BEmOC sites are being established at district level to provide wide coverage and access of Maternal and Newborn health
Three districts received funding from UNFPA through the Maternal Health Trust Funds in order to scale up the community RH activities. The districts have so far oriented Area Action Committees, Community safe motherhood task force, health workers and trained Village Health Committees.
PAC services have been scalled up to 28 new sites with support from ACCESS/USAID in November, 2008.
Services for young people are not available in most health facilities and where the services are available they are not adequately utilized by young people themselves. With the effort in training of health workers on Youth Friendly Health Services, provision of services has increased from 8% in 2006 to 50% of health facilities in 2009.
An expansion of 6 more facilities on Performance Quality and Improvement in Reproductive Health Standards (PQI-RH) was made bringing the districts oriented to RH standards to 20. All the 4 Central Hospitals have been incorporated in PQI-RH. Developing standards for RH has helped to set a yard stick by which the quality of RH services will be measured uniformly across the country.
Districts are also showing an interest in cervical cancer prevention by mobilising funds to train their health workers at district level.
More cases of obstetric fistula are being identified and operated in designated sites following a massive awareness campaign by RHU and partners.
The preliminary report of the strategic assessment is now available. The report indicates that most people interviewed admitted that deaths due to unsafe abortion occur in the communities and there are some deaths which are not reported to health facilities.
The report further indicates that more people are of the view that there should be some avenues to address such avoidable deaths due to unsafe abortion in Malawi so that Maternal Mortality Rate is reduced.
The effect of reducing unmet need in the districts where the DMPA is delivered at community level may not be captured in the DHS as it will be too early but can be inferred if the CPR has risen.
Enthusiasm of HSAs in delivering DMPA and the supervisory support provided by MSH who are implementing this project.
Secondly MSH has recruited CBDAs who are advocating for increased use of family planning and therefore increasing the number of clients who are available for DMPA and other methods.
Following the introduction of the non human condom dispenser in 2006 and the review exercise in September 2008, RHU embarked on a roll-out programme of the initiative to all the remaining 18 districts.
2.6.6. Tuberculosis
Tuberculosis continues to be one of the major public health problems in Malawi. The national TB response coordinated by the National TB Control Programme (NTP) continued with the approach of Directly Observed Therapy–Short course (DOTS) and progress is being made in many key result areas as outlined below:
1. 97% of diagnosed TB patients have been put on appropriate TB treatment (the target is 95%). There are still some hospitals that could not achieve the target.
2. TB case notification has reduced by 2% from 26,299 cases in 2007 to 25,684 cases in 2008
3. Cure rate among new smear positive cases has increased from 79 % in 2006 to 83% in 2007 (the WHO target is 85%). This has resulted in the treatment success rate reaching the WHO target of 85% for the first time in more than 15 years.
4. Death rate among the new smear positive cases has decreased from 11% in 2006% to 9% in 2007 .
5. Default rate has remained at around 3% (Target is below 5%)6. The percentage of TB cases accessing HTC services and accepting them has now
reached 84% throughout the country.7. The TB/HIV co-infection rate has decreased from 77% in 2000 to 63% in 2008 and
among them 57% accessed ART during their TB treatment 8. Districts continued to scale up establishment of community sputum collection points
to reduce distances that TB suspects travel to health facilities9. Government has now appointed a medical officer for prisons who will be responsible
for ensuring that TB control activities in prisons are monitored and reported
2.6.7. HIV/AIDS
Progress in the fight against HIV and AIDS pandemic continues to be registered in all districts. Recent reports indicate that there is a decline in HIV prevalence from 14 % to 12%. All the biomedical intervention areas namely HIV Testing and Counseling (HTC), management of HIV-related infections including provision of Antiretroviral Therapy (ART), Prevention of Mother to Child Transmission of HIV (PMTCT) and management of Sexually Transmitted Infections (STIs) continued to register significant achievements.
2.6.7.1. HIV Testing and counseling [HTC]
The number of people that were tested and counseled for HIV from July 2008 to June 2009 was 1.7 million against a target of 1.15 million. The National HTC Week Campaign was held in November 2008 and 186,217 people were tested for HIV during the week of which 7.2% tested positive. Out of 1.7 Million persons that received HTC services during the review period 10.8% were tested during the National HTC Week Campaign. This is the highest number of HIV tests performed in a single year, surpassing the target of 1.15 million by 562,170. The highest number of people tested was in the Southern Region which contributed 53.1% of all people tested, the Central Region contributed 34.2% and the Northern Region contributed 12.7 %. Among all people tested, 69.3% were females and 33.7% were males. Women that were pregnant at the time of testing constituted 28.1% of all persons tested. Of all persons tested, the proportion of people that tested positive was 11.6%. The proportion that tested positive in the Northern Region was 8.0%, Central Region was 9.35% and the highest positive proportion was from the Southern Region with 14.0%. A summary of progress in this area is in table
Table 6. Uptake of HIV Testing and Counselling July 2008 – June 2009
Indicator TotalTotal # tested and counseled 1,712,170% Tested in Northern Region 12.7%% Tested in Central region 34.2%% Tested in Southern Region 53.1%HIV + 11.6%% of Males 33.7%% of Females Non-Pregnant 38.2%% of Females Pregnant 28.1%% of First Time Testers 63.0%
% Testing as couples 11.2%% Tested 17months and below 1.3%% Tested between 18 months and 14 Years
6.4%
% Tested 14-24 years 37.6%% tested 25 years and above 49.6%# Referred for ART 144,900# Referred for PMTCT 61,091# Referred for TB 9,328
2.6.7.2. National HTC Week Campaign
The results of the HTC Week Campaign 2008 were as shown in Table 3 below.
Table 7. Results of the HTC Week Campaign 2008No Northern
RegionCentral Region
Southern Region
Malawi
1 Total Number of persons tested 35,873 70,726 79,618 186,2172 Males 16,515 32,703 33,963 81,1813 Females non-pregnant 16,850 30,490 37,365 84,7054 Females Pregnant 2,508 7,533 8,290 18,3315 HIV Positive 4.2% 5.4% 10.2% 7.2%
2.6.7.3. HIV care and treatment
Good progress in this key area has been the continued increase beyond set targets in number of people who are alive and on ARVs Progress in this area is summarized in table below:
Table 8: Patients Alive and on Treatment December 2006 – June 2009
No Year Target Achievement
1 December 2006 60,000 59,980 [ - ]
2 June 2007 70,000 79,398 [ + ]
3 December 2007 90,000 100,649 [ + ]
4 December 2008 130,000 147,479 [ + ]
5 June 2009 150,000 169,965 ( + )
2.6.7.4. Prevention of mother to child transmission of HIV Overall the performance of PMTCT programme is summarizes achievements in the table below. However due to lateness in reporting in three districts only outputs between July 2008 and March 2009 are presented.
Table 9: Achievements, July 2008 – March 2009
# of sites (cum)
New ANC
# women tested
# of pregnant women HIV+
Mother ARV prophylaxis
Mother CPT
Infant Prophylaxis
Infant CPT
518 335,300
327,400 33,255 25,822 26,256 (includes women with old HIV status identified in ANC)
15,407 19,069
Under-performing districts: Mzimba, Dedza, and Mulanje.
2.6.8. Onchocerciasis
Progress made in onchocerciasis has been the treating of 1,597,659 out of 1,936,129 people representing treatment coverage of 82.5%.The annual MDA is reducing the itching and skin problems in populations around onchocerciasis endemic districts.
2.6.9. Lymphatic filariasis
This year Malawi has started implementation of LF mass treatment in 8 districts. treatment. Over the review period, the major progress made is that LF was fully integrated in terms of training and mass treatment with Onchocerciasis programme and also with other programme campaigns such as Malaria/ITN, Primary Eye Care [PEC] and Vitamin A/Measles campaign.
Mass Drug Administration [MDA] conducted treated 2,704,323 out of a total of 3,358,816 at risk population representing 80.5% from districts of southern region of Malawi in Blantyre, Chikwawa, Chiradzulu, Mulanje, Mwanza, Neno, Phalombe and Thyolo.The exercise also identified 1,427 cases of Hydrocoele out of which 212 cases benefited from surgical operations..
2.6.10. Health education services
Progress in health education services has been made in the areas of creating public awareness, facilitating community involvement and participation and promoting activities which foster health behaviour and encouraging people to want to be healthy.A total of 94 film shows in hard to reach areas and 123 band performances were done during the review period The shows and band performances focused on social mobilization campaigns in the areas of HIV/AIDS, Malaria, TB, cholera SRH, water and sanitation and many more. Another area where progress has been made is in conducting nine separate world commemoration events for health to launch annual themes around specific health topics. While there was good progress at service delivery point, the Health Education Unit continued with the development of various IEC materials including print materials, material for radio, outdoor advertising, media coverage, and behaviour change interventions at district level to support delivery of behaviour change interventions. All material produced during the year have been pre-tested and most have been printed and are being distributed.
2.6.11. Environmental health services
The mission of Environmental Health Section is to develop criteria and prescribe health quality standards, enforce and monitor compliance with statutory standards and to establish and implement preventive and promotive intervention measures to protect human health.The main activities implemented last year were aimed at improving water quality and sanitation, promoting food hygiene and quality control, protecting human environment. raise public awareness on environmental health issues. Results from routine monitoring of water quality indicate that most of the water supplies in rural areas are contaminated. On port health progress has been made in deployment and training. The major activities carried out at ports of entry are travellers’ health checks, quarantine, surveillance and personal advice to travellers on health risks such as malaria, bilharzia and other prevailing illnesses and diseases.
On Avian influenza the Ministry made several press releases on press media and made investigation of suspected AI outbreaks in birds in Ntchisi and ZombaSwine flu sensitization of health personnel in boarder districts is another key progress made in this key area
2.7. Strategy/Pilla.r 6 : Strengthen Policy development standards setting supervision, monitoring and evaluation
A number of policy documents, guidelines and standards were developed during the year under review. Some of these documents have been finalized and are being used, whilst others are still in draft form awaiting input from a broad range of stakeholders. Details on the status of specific policy documents, standards and guide lines are outlined below:
2.7.2. Policy development
2.7.2.1. National Health Policy and Health Act
The national Health Policy is in its final stages of development. All technical consultations have been completed, what remains is input from Principal Secretaries Committee and Cabinet. Similarly, technical input into the proposed health act has been completed and legal experts are now working on the document.
2.7.2.2. Clinical management
Two key policy development documents have been developed:Traditional medicine policy and the Malawi Standard Treatment Guidelines (MSTG).Both policy documents have not yet been disseminated and its implementation has not yet started.
2. 6. 1. 3. PharmaceuticalNational Medicines and Medical Supplies Policy revised National Pharmaceutical Strategic Plan developed
2. 6. 1. 4. HTC Guidelines.
The Review of HTC Guidelines (2004 Edition) which began in 2007 was completed. The process involved consultation with various stakeholders and presentation to technical sub-groups and TWG meetings. The printing of the guidelines is awaiting release of RCC funding.
2. 6. 1. 5. Paediatric HTC Guidelines.
The Paediatric HTC guidelines of 2007 were reviewed in 2008-9. This review is now completed and UNICEF is assisting with printing of this document.
2. 6.1.6. Development of the Child HIV Counseling Guide
A draft Child HIV Counseling Guide has been completed. A workshop with a group of senior HTC counselors was held from 30th March to 4th April at Mt Soche Hotel in Blantyre to pre-test the draft guide. Comments and additional information were inserted into the guide. By the end of June the final draft of the Child HIV Counseling Guide had not been completed. When completed in the first quarter of 2009-10 year, the guide will be the basis for a five day MOH approved Child HIV Counseling Training Course.
PMTCT guidelines
PMTCT guidelines have been revised to incorporate combination ARV prophylaxis.National ANC and maternity registers, and women health passports have been printed .
TB/HIV guidelines
TB/HIV guidelines have been drafted and will be finalised before December 2009.
Pre ART programme
Minimum package for Pre-ART has been developed following a stakeholders meeting. This will form the basis for the guidelines for the Pre-ART programme.
ART guidelines
ART Guidelines 3rd Edition has been produced and OI guidelines have also been revised M & E tolls have also been revised and the new ART registers, New ART Master cards and new patient ID’s have been distributed to the Health Facilities
National condom strategy
The document has been reviewed and revised. All key stake holders were involved throughout the process. The final draft document is due for proof reading by experts. The documents is aimed at filling identified gaps and improve on the supply chain management. It ensures promotion of both male and female condoms with reflection on the HIV prevention strategy.
Health promotion policy
Health Promotion Policy which embraces current trends and emerging issues and challenges within the health promotion and communication field was developed .TheNational Health Promotion five year Strategic Plan (2009 – 2014) is in its final stages.
Participatory Hygiene 2nd Sanitation Transformation (PHAST) training manual
Development of PHAST training manual , PHAST training guide , and a zero draft PHAST tools kit was done during the period under review .This is aimed at helping training of health extension workers.
HSAs Training Curriculum and Job description
The HSA training curriculum and job description was reviewed. over the period under review. The process also resulted in the development of a trainer’s manual and facilitators guide for the same cadre. Currently the documents are being processed for printing with financial support from UNICE
National Sanitation Policy Development
The National Sanitation Policy for Malawi was sent to cabinet and the policy was approved early this year. This activity was done jointly with the Ministry of Irrigation and Water Development
Water Quality Monitoring
The development of a training manual on Water Quality Monitoring for the health extension workers was finalized in the same period under review
Food Safety and Hygiene
Three policy documents were developed in this key area namely1. Food Safety and Hygiene strategic Plan. 2. Food Safety and Hygiene training manual.3. Food Safety and Hygiene activities monitoring tools.
Avian influenza:
The following activities related to avian influenza were carried out during the period under review:
1. Development of AI Preparedness Plan 2. Development of the one year implementation plan3. Development of communication plan for AI4. Development of AI messages.
A task force and a technical committee have been instituted to provide guidance on the implementation of the plan and dissemination of messages
HINI Influenza ( Swine Flue)
Progress made in this area is:1. Formation of the National Task Force on Swine Flu2. Formation of National Technical Committee on Swine Flu3. Development of SF Preparedness Plan 4. Sensitization of health personnel in boarder districts
Hospital Care for Children
A WHO Pocket book for Hospital Care for Children in low resource countries to act as a reference material for the standards of hospital care for children in Malawi was reviewed and adapted .
Highly pathogenic type A influenza specimens
Standard Operating Procedures (SOPs) for collection, processing, storage, packaging, transportation and testing of Highly Pathogenic Type A Influenza (H5N1 and novel H1N1) specimens were developed by the public health laboratory section PHL
Laboratory based surveillance
National Laboratory Based Surveillance System for viral infectious diseases was developed and a draft framework developed and has been circulated for input and commenting to various stake holders.
Nursing and Midwifery related Policies
No Programme Type of policy document Status / remark1 Nursing Education Nursing midwifery strategy
‘committed to care’Draft waiting for stake holders meeting
In-service education guide Final draft2 Community Based
NursingPalliative care guidelines Draft, for stakeholders
consultative meetingsPalliative care training manual for Volunteers
First draft, for consultative meetings.
Integrated School Health Nutrition strategy
Developed in collaboration with the MOEST, Now final draft will be presented to both ministries (MOH & MOEST) for approval.
School Health Nutrition guideline
Community health nursing To be presented to
road map senior management for their input
School health in-service refresher manual for health workers
Final draft for pretesting
3 Quality Assurance Nurses and midwives standards.
Finalized , for printing & dissemination
Review of IP standards & guidelines
Finalized waiting for dissemination through zone meetings
Job descriptions Developed waiting for MOH official comments
Progress on Governance Structures
Most Technical working groups (TWGs) did not manage to meet for four times as scheduled. On average TWGs met twice with exception of the Quality Assurance TWG which never met. Failure to meet was attributed to busy schedule of Chairpersons. To address this problem, all TWGs have a now a co-chair who can conduct meetings if the chair person is busy with other duties. Proposed amendments to the SWAP MOU have now been agreed upon by most partners and signing of the amended version will take place any time in the next financial year.
Progress at activity level
Most activities outlined in workplans of all departments of the MoH have been implemented. Activities targeting milestones and recommendations made during the last reviews and the recommendations from the recent 2008/2009 Midyear Review were implemented at different degrees. Progress on milestones and recommendations from midyear reviews has been presented in various areas of this report
Financial Management
The main focus of this report is to provide the financial performance of Health Sector Wide
Approach for the year ended 30th June 2009.
The SWAP Program of Work continues to be financed by government and a number of
cooperating partners who are either - pool partners who provide funding through a common
bank account or discrete partners who finance specific items in the POW.
Total expenditures under the PoW in the first four years of the SWAp - 2004/05 through
2007/08 - have been MK 7.31, 13.23, 16.21 and 22.47 billions, respectively. The budget
approved for 2008/09 is MK31.18 Billion.
Accounting policies
The principal accounting policies adopted in the preparation of the consolidated statement of
receipts and payments are set out below: -
Basis of preparation
The consolidated statement of receipts and payments has been prepared in accordance
with Malawi Government accounting system under the cash basis accounting
convention.
(i) Receipts
Receipts represent actual funding received from GoM and from Development
partners, for both pooled funds and discrete funds.
Pooled funding comprises funding from donors and from Government of Malawi.
Most funds from pooled donors are paid to the Foreign Currency Denominated
Account (FCDA) held at the Reserve Bank of Malawi. From this account, some
payments are made directly to suppliers, with the balance being transferred when
required to the Malawi Kwacha SWAp account; or to the Malawi Government
Consolidated account (MG1). Other pooled donor funding is paid by donors directly
to suppliers. Apart from such direct payments to suppliers, funding of health sector
cost centres is done through the normal monthly Treasury funding from MG1.
Discrete funding comprises funds for specific development projects both from GOM
and from donors
(ii) Payments Payments are made in Malawi Kwacha through the various operating bank
accounts. The payments represent actual amounts derived from the respective cost
centres’ expenditure returns as submitted to the Ministry of Health for
consolidation.
(iii) Foreign currency transactions
Foreign currency transactions are translated into Malawi Kwacha using exchange
rates prevailing on the dates of the transactions. Any exchange gains or losses arising
from translation are included in the consolidated statement of receipts and payments.
FINANCIAL PERFORMANCE FOR THE QUARTER AND YEAR
Below is a combined statement of receipts and payments for the year ending 30th June 2009 in
Billions of Malawi Kwacha.
TOTAL FUNDING
Funding input consists of the following different elements:
a. Donor pooled funding to the MOH SWAp US dollar bank account.
b. GOM pooled funding to cost centres to meet their recurrent needs and also for pooled
development projects. This pooled funding is provided from GOM’s main MG1 bank
account, which is supplemented from sums drawn from the SWAp bank account. Thus
GOM’s pooled input is the net of these two.
c. Discrete funding, which is partly from Donors and partly from GOM. Discrete funding
from Donors includes funding of the donor share of most budgeted development projects,
but excludes those that are pooled. It also includes unbudgeted projects such as those
funded by NAC and UNICEF. GOM funding of discrete projects consists of GOM’s share
of budgeted development projects.
Donor pooled fundingDonor pooled funding (category a. above) is summarized in the Table 1 below:
Funding from each Donor
Amount pledged for 2008/09
Amount disbursed 4th
quarterUSD m USD m USD m %
DFID 33.7 11.5 31.8 94%Norway 19.8 8.5 16.1 81%Global Fund 31.1 3.7 47.9 154%KfW 7.8 3.6 6.8 87%UNFPA 0.3 0.2 0.3 110%UNICEF 0.3 0.0 0.3 100%World Bank 1.0 0.0 3.0 300%Grand Total USD m 94.1 27.5 103.2 110%MK B equivalent 3.93 14.39 Exchange gain/(loss) 0.00 -Grand Total MK B 3.93 14.39
Cumulative disbursed in year to date
The total sum pledged from donors for 2008/09 was $94.1million. During the fourth quarter,
donor pooled funding was received as shown in Table 1 above in the column labeled “amount
disbursed in 4th quarter”. As at end June 2009, total donor pledges for the year had reached
110%. It is notable that World Bank pledged US$1million but disbursed US$3million for a
project that ended in September 2008. Similarly, Global Fund had pledged US$31.1m but
actual disbursement was at 154%. This is a positive indication of the Development partner’s
commitment to support GoM to address major health issues through Health Sector Wide
Approach (SWAp).
GOM pooled fundingFunding by GOM to the pool (category b. above) is summarized in Table 2 below in MK
billions:
Pooled GOM funding
Approved budget for 2008/09
Amount disbursed 4th
quarterMK B MK B MK B %
From MG1 to cost centres (recurrent) 26.28 4.81 24.82 94%Pooled development funding 3.83 0.54 1.59 42%From SWAp a/cs to MG1 (1.05) (12.06) Sundry revenue 0.02 (0.06) Net Pooled GOM Funding 4.32 14.29
Cumulative disbursed in year to date
GoM recurrent funding to cost centres as at 30th June 2009 was cumulatively 94% of the
budget for the year. Meanwhile, pooled development funding from GOM was low at 42%.
Discrete fundingDiscrete funding, category c. above, is summarized in the following Table 3 in MK Billions:
Discrete projects fundingApproved budget for
2008/09
Amount disbursed 4th
quarterMK B MK B MK B %
Discrete development funding from donors:ADF/ADB (ADFB IV) 1.90 0.09 0.86 45%OPEC (Phalombe hospital construction) 0.27 0.00 0.00 0%OPEC (Nkhata Bay hospital construction) 0.27 0.00 0.00 0%Norway (Replacement of Zomba central) 0.50 0.00 0.00 0%
Total discrete development donor funds 2.93 0.09 0.86 29%Discrete development funding from GoM 0.06 0.30 0.36 588%Unbudgeted donor discrete funding
NAC - 0.04 UNICEF support 0.14 0.30 Unbudgeted donor discrete funding 0.01 0.70
Total Discrete Funding 2.99 0.54 2.27
Cumulative disbursed in year to date
As at end June 2009, ADB had disbursed MK0.86bn which is 45% of the annual pledge.
Meanwhile, it should be noted that OPEC confirmed that they were not disbursements in the
year.
In addition, at the end of June 2009, funding for unbudgeted projects was received from the
following discreet donors:
NAC disbursed MK0.4bn. Of course NAC also made some direct
disbursements to UNICEF, College of Medicine, and Ministry of Finance
amounting to MK6.04bn in respect of Health activities.
UNICEF disbursed MK0.3bn
KfW disbursed MK513.9m (US$3.62m)
GTZ disbursed MK70.3m
Combined pooled funding
Table 4 below analyses the 2008/09 funding to cost centres between GOM and donors in
accordance with the proportions adopted when the SWAp PoW was originally costed:
Total GOM Donors Total GOM Donors GOMDon'MK B MK B MK B MK B MK B MK B % %
Total funding input (as above) 8.25 4.32 3.93 28.68 14.29 14.39 Funding to cost centres PE funded by MG1 1.73 1.37 0.36 6.77 5.35 1.42 79% 21%ORT (including drugs) funded from MG1 3.08 1.39 1.69 17.99 8.10 9.90 45% 55%Pooled development funding - - - 0.05 0.02 0.03 Total from MG1 4.81 2.75 2.06 24.82 13.47 11.35 ORT funded from SWAp FCDA a/c - - - 1.83 0.83 1.01 45% 55%Devel'mt funding from MG1 via deposit a/c 0.54 0.24 0.30 1.59 0.72 0.88 Total funding to cost centres (CCs) 5.35 3.00 2.35 28.24 15.01 13.23 Input over/(under) CC funding 2.90 1.32 1.58 0.44 (0.72) 1.16
4th Quarter Cumulative to 30 June 2009
Analyzing the cumulative position for the year, it can be seen that GOM has under-funded by
MK0.72bn this year, whereas donors’ over-funding is MK1.16bn.
The picture presented in Table 5 below combines the result for the current year to date with
that of previous financial years since the start of the SWAp, with figures taken from the
accounts to 30th June 2008, using the same ratios as above. The combined result is as follows:
Total GOM Donors
Input over CC funding in 2008/09 as above 0.44 (0.72) 1.16 Input over expenditures at the end of 2007/08 6.96 7.43 (0.47)
Cumulative input over CC expenditures 7.39 6.70 0.69
Reconciliation to SWAp accounts MK BSWAp account bank balances 6.66 Other pool bank balances 0.09 Balance with UNICEF -Closing commitment & accruals balanceSWAp account use for discrete 0.64
7.39
This analysis shows how cumulatively, the GoM funding has exceeded its share of spending
by MK6.70bn while donors funding have exceeded their share by MK0.69bn. On this basis,
all the balances in the SWAp accounts are attributed to GoM.
.POOLED FUNDING AND EXPENDITURE BY MOH LEVEL
Table 6 below analyses pooled funding to cost centres (recurrent plus funding of pooled
development projects). The funding is divided into PE, ORT excluding drugs, and Drugs.
Drugs relate to drug funding from Treasury for purchases by cost centres, mostly from
Central Medical Stores (CMS). The analysis is by level, i.e. Headquarters (HQ), Central
Hospitals (CH), District Health Offices (DHO), Health Service Commission (HSC), and
CHAM. Figures are for the quarter to end June 2009 and are in MK millions:
HQ CHs DHOs HSC CHAM TotalMK m MK m MK m MK m MK m MK m
PE 250 1,118 3,384 27 1,994 6,773ORT 10,866 1,419 8,051 55 0 20,391Drugs (CHs only) 0 1,078 0 0 0 1,078Total 11,116 3,616 11,435 82 1,994 28,242
PE 362 1,110 3,590 30 1,994 7,085ORT (excl drugs) 12,038 1,383 5,389 39 18,848All drugs 0 986 2,399 3,385Total 12,399 3,479 11,377 69 1,994 29,318
PE 205 956 2,839 31 2,810 6,841ORT (excl drugs) 12,710 1,417 5,286 55 0 19,469All drugs 0 1,081 2,715 0 3,795Total 12,915 3,454 10,840 86 2,810 30,105
Pooled budgets by funding category:
Pooled expenditures by funding category:
Recurrent & direct supplier funding from MG1 plus ORT payments from SWAp account:
Table 7 below shows percentages calculated from the table above:
HQ CHs DHOs HSC CHAM Total
PE 121.9% 117.0% 119.2% 86.7% 71.0% 99.0%ORT 85.5% 100.2% 100.6% 100.0% 0.0% 104.7%Drugs (CHs only) 0.0% 99.8% 0.0% 0.0% 0.0% 28.4%Total 86.1% 104.7% 105.5% 95.2% 71.0% 93.8%
PE 144.8% 99.3% 106.1% 111.2% 100.0% 104.6%ORT 110.8% 97.4% 96.7% 70.9% 0.0% 92.4%Drugs (CHs only) 0.0% 91.4% 0.0% 0.0% 0.0% 313.9%Total 111.5% 96.2% 99.5% 84.0% 100.0% 103.8%
PE 176.5% 116.1% 126.4% 96.4% 71.0% 103.6%ORT (excl drugs) 94.7% 97.6% 101.9% 70.9% 0.0% 96.8%All drugs 0.0% 91.3% 88.4% 0.0% 0.0% 89.2%Total 96.0% 100.7% 105.0% 80.0% 71.0% 97.4%
Proportions of budget funded:
Proportions of funding utilised:
Proportions of budget spent:
Significant features are:
Treasury is funding PE at a rate in excess of the original budget. This is shown by the
percentages that are higher than 100% - HQ with 121.9% of budget funded, CHs with
117.0%, and DHOs at 119.2%.
In the case of HQ, the PE figures differ from those in the financial statements due to
payments totaling MK833m in the year to date - for salaries of new HSAs, which had not
yet been charged to DHOs, and for UNV doctors – as this sum, which has been charged
to PE in the financial statements, was funded by ORT and so has been included under
ORT above to avoid distortion to the percentages.
The division of ORT funding from Treasury into ORT excluding drugs and drugs alone is
inconsistent between the various levels, as Treasury do not report DHOs’ drug funding
separately from non-drugs ORT.
HQ was funded 85.5% of the year’s ORT budget; CHs were funding 100.2% (excluding
drugs) and DHOs 100.6%. Meanwhile, CH’s drugs funding was 99.8% of budget.
On ORT utilization of funding received, HQ was at 110.8%, CHs (excluding drugs) at
97.4% and DHOs at 96.7%. Note that CH’s utilization of drugs funding was only 91.4%.
Meanwhile, the proportion of DHOs’ drugs budget spent was only 88.4% in the 12
months, compared to 101.9% for non-drugs ORT, an indication that some DHOs were
utilizing their drugs budget for non-drugs ORT spending.
POOLED DEVELOPMENT & DISCRETE FUNDING & EXPENDITURES
Table 8 below shows that the funding and implementation of discretely-funded projects at the
end of June 2009, reached 81.4% and 64.9% of budget respectively, while pooled
development projects expenditures were slow at 45.1%.
Budget Actual
Funding MWK
Millions MWK
Millions Use of budget
Pooled development funding 3,879 1,643 42.4%Discrete funding (as above) 2,992 2,437 81.4%Total funding 6,871 4,080 59.4%
ExpenditurePooled development projects 3,879 1,750 45.1%Discretely-funded projects 2,992 1,941 64.9%Total expenditure 6,871 3,691 53.7%
SUMMARY OF ALL EXPENDITURES
A summary analysis of total expenditure by pillar is detailed in Table 9 below, covering
recurrent expenditure, development expenditure and expenditure on unbudgeted discrete
projects:
2008/09
Approved
Budget Planned Actual Variance Use of
planned Use of budget
MWK Millions
MWK Millions
MWK Millions
MWK Millions % %
1.0 Human Resources 8,214 6,776 9,825 -3,049 145.0% 119.6%2.0 Pharm's, Med' and Lab' Supplies 4,885 4,885 6,532 -1,647 133.7% 133.7%3.0 Essential Medical Equipment 1,021 1,021 755 266 73.9% 73.9%4.0 Infrastructure 7,196 7,196 3,138 4,057 43.6% 43.6%5.0 Routine Operations (service level) 5,136 5,136 5,470 -334 106.5% 106.5%6.0 Support to Inst'ns and Sys Dev 6,645 6,645 5,538 1,107 83.3% 83.3%Total Use of Funds by POW PILLAR 33,097 31,659 31,259 400 98.7% 94.4%
Cumulative to 30 June 2009
This analysis shows total expenditure of MK31.3bn at end of June 2009, being 94.4% of the
year’s budget.
Pillar 1: Human Resources
HR expenditure was 119.6% of budget, mainly because Treasury was funding PE in excess of
the amount approved by parliament.
Pillar 2: Pharmaceuticals, Medical and Laboratory suppliers
Expenditure under this pillar in the 12 months was 133.7% of the budget for the year,
probably reflecting the fact that some cost centres were paying arrears to Central Medical
Stores.
Pillar 3: Essential Medical Equipment.
Expenditure under this pillar was slow at 73.9%. Pillar 4: Infrastructure
Expenditure on infrastructure was also slow at 43.6% on major projects, compared to budget,
such as on the construction of staff houses.
Pillar 5: Routine operations at Service Delivery level
Routine operations expenditure was 106.5% of budget for the year.
Pillar 6: Support to Central Operations, Policy and Systems Development
Expenditure of under this pillar was 83.3% of the year’s budget. The total includes two large
transactions which had not been fully reflected in the original budget. One is a payment to
UNICEF of MK1.8bn for malaria drugs, for which a virement was approved by Treasury.
The other was purchases for CMS of over MK1.8bn.
CONCLUSION
The overall implementation of 2008/2009 budget was good with only three pillars overspent.
As at end June 2009, 94.4% of the budget was used. The Ministry’s priority now is to begin
the audit for 2008/09 and to get up-to-date with collation of expenditure returns from cost
centres for the first quarter FMR of 2009/2010 financial year.
Procurement System
Implementation of the Procurement Improvement Plan.
Progress in the implementation of the procurement improvement plan has not been very satisfactory:
Fewer trainings and supervisions have been conducted due to lack of resources. Only one officer from the headquarters has been sent on a master’s degree programme
in procurement. Some officers have, using their own resources, enrolled for a master’s degree program at MIM.
While positions for procurement officers have now been created in all district and central hospitals, the staff vacancy rates remain high. All district hospitals do have qualified procurement officers in place. Not all positions have been filled for procurement officers in the central hospitals. Common Service for public procurement cadre now established.
Oversight Arrangements in Procurement. Following the pulling out of the World Bank from the health SWAp in September 2008, Pool Partners could not finalize oversight arrangements for all health SWAp procurements until November 2008 when it was agreed to recruit an interim procurement oversight firm for non health products. DFID had offered to facilitate the recruitment of the interim oversight firm. The contract for the interim oversight firm expired in January 2009 and it was expected that the intermediate oversight firm would be recruited with financing from DFID by February 2009. As at January 2009, expressions of interests for the intermediate oversight firm had been done. DFID extended contract with Charles Kendall to coincide with the recruitment of the intermediate oversight firm. Intermediate firm was expected to be in place by end April.
Recognizing that some medical supplies are so critical, pool partners and government agreed that UNICEF could be used in the procurement of health related supplies including drugs,
vaccines and other medical supplies. UNICEF however agreed to be responsible for procurement of the following under the new arrangement with government: Vaccines and ITNs, Nutrition supplies, GFAM funded supplies for AIDS, TB, and Malaria
Thus, the majority of the medicals supplies not to be procured through UNICEF would still have to be procured through Central Medical Stores. To date, the procurement unit has only facilitated the following GAVI funded procurements through UNICEF: BCG, OPV, Measles and TT vaccines, Immunization Devises and DTP-HepB-Hib vaccine totaling USD2,077,037.16 and nutrition supplies totaling USD748, 683.40. Funds in respect of the above procurements were transferred to UNICEF account. As at the time of compiling this report, deliveries for the above supplies had not yet taken place. Some Global Fund funded supplies for malaria have been submitted for procurement to UNICEF.
An Action to address cases of misprocurements raised in the 2006/2007 procurement audit report was developed and circulated to all SWAp Pool Partners. The action plan was executed accordingly
Implementation of the 2008/2009 Procurement Plan. Due to delays in agreeing on oversight arrangements on procurement and finalization of the procurement plan, the majority of the high value procurements requiring international competitive bidding procedures could not be implemented during the first half of the year as planned. The procuring unit was making efforts to float all such tenders in the second half of the financial year. However, due to budget overruns in the ministry, the majority of the high value procurements could not be undertaken during the financial year. See progress as per table below:
Name of Contractor/Suppliers/consultant and his address Nature of Contract
Date of tender/RFQ
Date of closure of tender
Approved method of procurement
Reasons for change of method
Date of Contract award
1Kingfisher Insurance Brokers
Provision of Motor Vehicle Insurance Services
01/04/2008
05/09/2008 NCB NA
07/01/20
2 Pasimalo Security ServiceProvision of security services
14/12/2006
15/01/2007 NCB NA
05/02/20
3 Pasimalo Security ServiceProvision of security services
14/04/2008
15/05/2008 NCB NA
01/07/20
4 Queen Margaret University
Consultanct services for District Expenditure Pattern NA NA SSS NA
25/11/20
5Dziko/Mkatha Building Contractors
Rehabilitation of Balaka distric Hospital Apr-08 22/05/08 NCB NA
09/09/20
6 MMSPKT Contractors
Rehabilitation of Zomba Central Hospital
02/06/2008
21/03/2008 ICB NA
23/07/2008
7 Hualong Contractors
Rehabilitation of Zomba Central Hospital
02/06/2008
21/03/2008 ICB NA
23/07/2008
8Computer Connections Limited
Consultancy for drawing up of inventory for IT Equipment in the ministry of Health
08/01/2008
08/07/2008 RFQ NA
26/08/20
9 Pabu Building Contractors
Rehabilitation of Mzuzu Central Hospital Sewage NCB
10 AMPROC
Consultancy for Procurement Audit for Ministry of Health SWAP
14/03/2008
06/01/2008 ICB NA
24/09/2008
11 Hub Media Group
Consultancy for TV Documentary
22/09/2008
24/09/2008 RFQ NA
16/10/20
12 Sungani Mtande
Installation of Access Software in Accounts
11/05/2008
11/12/2008 SSS NA
28/01/2009
13 Zingano and Associates
Design of the New Nkhatabay District Hospital May-07
31/05/2007 NCB NA
52 Months
14 Zingano and Associates
Supervision of the New Nkhatabay District Hospital May-07
31/05/2007 NCB NA
52 Months
15 Speedy General Dealers
Procurement of stationary on framewoek contracts
10/03/2006 30/11/06 NCB NA 27/02/07
16 A.J stationary
Procurement of stationary on framewoek contracts
10/03/2006 30/11/06 NCB NA 27/02/07
17 CFAO
Procurement of 6 Double Cabs
05/03/2008 13/07/08 ICB NA
18/08/2008
18 Toyota Malawi
Procurement of one Station Wagon
05/03/2008 13/07/08 ICB NA
18/08/2008
19 Xerographics Limited
Purchase of 125 computers and software
17/03/2008 30/04/08 ICB NA
23/07/2008
20 Gestetner Limited Office Equipment
17/03/2008 30/04/08 ICB NA
23/07/2008
21 Centre for Social Research
Procurement of Consultancy services to conduct HRM Census 15/08/07 30/08/07 ICB NA 18/10/07
22 Chancellor College
Procurement for Consultancy Services for Team Building 29/06/07
27/7/2007 NCB NA
30/10/2007
23 GITEC
Health Facility Assessment Survey
12/01/2007
29/02/2008 ICB NA
05/01/20
24 Roja Construction Company
Rehabilitation of Ministry Headquarters
06/01/2007
07/02/2007 NCB NA
07/03/20
25
Chikpnde Electrical Contractor
Rehabilitation of Ministry Headquarters-Electrical
06/01/2007
07/02/2007 NCB NA
07/03/20
25 MA-WI Tech
Printing of IEC Materials for World TB Day 15/01/08 19/01/08 RFQ NA 22/01/08
26 Agri-Visual Limited
Procurement of an Audio Visual Van 15/03/08 15/04/08 ICB NA 17/07/08
27
Computer Connections Limited
Supply and installation of an anti-virus 25/09/07
10/02/2007 RFQ NA
10/02/20
28 Parad Limited
Procurement of 40 Desk Computers and 40 Laser jet Printers
19/01/2008
26/01/2008 RFQ Urgent
03/02/20
29 Mercantile International
Printing of TB 2500 Strategic Plan
09/07/2008 15/10/08 RFQ NA
11/11/20
30 Winiko Theatre Company Drama Awareness 14/01/09 21/01/09 SS NA 22/01/09
31 Venus Printing
Printing of 25,000 5 Development Plan
09/11/2008 18/09/08 RFQ NA 19/09/08
32 Liu Construction
Rehabilitation and extension of BEmOC Health Centres ( Chisoka, Khonjeni, Chonde, Namitambo, Namadzi and Domasi Health Centres)
14/04/2008
15/05/2008 NCB NA
01/07/20
33 Tafika Building Contractors
Rehabilitation and extension of BEmOC Health Centres (Phimbi, Mbendera, Mtanja, Nainunji, Makhuwira, Monkey-bay, Phiri longwe and Nankuma)
14/04/2008
15/05/2008 NCB NA
01/07/20
34
Malaya Building Contractors
Rehabilitation and extension of BEmOC Health Centres (Kawamba, Kaluluma, Santhe, ChuluChankhungu and Chizolowondo)
14/04/2008
15/05/2008 NCB NA
01/07/20
35
Hualong Construction (PVT) Limited
Rehabilitation and extension of BEmOC Health Centres (Kochilira/ Nkhwazi, Chitedze, Ming'ongo,Nsalu, Nsalu, Chimbalanga and Mtenthera)
14/04/2008
15/05/2008 NCB NA
01/07/20
36
Nangaunozge Building Contractors
Rehabilitation and extension of BEmOC Health Centres (Lobi, Chikuse, Ganya, Kapeni, and Lizulu)
14/04/2008
15/05/2008 NCB NA
01/07/20
37
Fukumere Building Contractors
Rehabilitation and extension of BEmOC Health Centres (Ntharire, Misuku, Kapolo and Chilumba)
14/04/2008
15/05/2008 NCB NA
01/07/20
38 China Gansu Contractors
Rehabilitation and extension of BEmOC Health Centres (Enukweni, Mhuju and Bolero)
14/04/2008
15/05/2008 NCB NA
01/07/20
39
Hualong Contruction Pvt Limited
Rehabilitation and extension of BEmOC Health Centres (Mzuzu, Jenda, Bula, Chintheche and Liuzi)
14/04/2008
15/05/2008 NCB NA
01/07/20
40 Design Printers
Printing of Chronic Cough Registres
05/12/2007
12/12/2007 RFQ Urgent
13/12/20
41 Xerographics Limited
Purchase of IT Equipment Apr-08
16/05/2008 NCB NA
03/07/20
42 Gestetner
Purchase of Office Equipment Apr-08
16/05/2008 NCB NA
03/07/20
43 IT Centre
Purchase of IT Equipment Apr-08
16/05/2008 NCB NA
03/07/20
44 Gestetner
Purchase of Office Equipment Apr-08
16/05/2008 NCB NA
03/07/20
45
Fukumere Building Contractors
Umoyo Housing Project: Chitipa
14/04/2008
15/05/2008 NCB NA
01/07/20
46
Hualong Construction (PVT) Limited
Umoyo Housing Project: Karonga
14/04/2008
15/05/2008 NCB NA
01/07/20
47
Mwendayekha Building Contractors
Umoyo Housing Project: Rumphi
14/04/2008
15/05/2008 NCB NA
01/07/20
48
Tikhalenawo Building contractors
Umoyo Housing Project: Mzimba/Nkhatabay
14/04/2008
15/05/2008 NCB NA
01/07/20
49 Wahkong Construction
Umoyo Housing Project: Mzimba
14/04/2008
15/05/2008 NCB NA
01/07/20
50 Liu Construction
Umoyo Housing Project: Kasungu/Mchinji
14/04/2008
15/05/2008 NCB NA
01/07/20
51
Intercity Building Contractors
Umoyo Housing Project: Dowa/Ntchisi
14/04/2008
15/05/2008 NCB NA
01/07/20
52
Nangaunozge Building Contractors
Umoyo Housing Project: Nkhotakota/Salima
14/04/2008
15/05/2008 NCB NA
01/07/20
53
Hualong Construction (PVT) Limited
Umoyo Housing Project: Lilongwe
14/04/2008
15/05/2008 NCB NA
01/07/20
54 Delta Construction
Umoyo Housing Project: Dedza
14/04/2008
15/05/2008 NCB NA
01/07/20
55 Delta Construction
Umoyo Housing Project: Blantyre/Mwanza-Mneno
14/04/2008
15/05/2008 NCB NA
01/07/20
56 Delta Construction
Umoyo Housing Project: Balaka/Mangochi
14/04/2008
15/05/2008 NCB NA
01/07/20
57 Tafika Building Contractors
Umoyo Housing Project: Zomba
14/04/2008
15/05/2008 NCB NA
01/07/20
58 Project Building Contractors
Umoyo Housing Project: Balaka/Machinga
14/04/2008
15/05/2008 NCB NA
01/07/20
59 BM Contractors Limited
Umoyo Housing Project: Mangochi/Machinga
14/04/2008
15/05/2008 NCB NA
01/07/20
60
Malaya Building Contractors
Umoyo Housing Project: Machinga
14/04/2008
15/05/2008 NCB NA
01/07/20
61 Wahkong Construction
Umoyo Housing Project: Phalombe/Mulanje
14/04/2008
15/05/2008 NCB NA
01/07/20
62
Nangaunozge Building Contractors
Umoyo Housing Project: Chiradzulo/Mulanje
14/04/2008
15/05/2008 NCB NA
01/07/20
63
Computer Connections Limited
Supply and installation of an anti-virus
25/02/2008
04/03/2008 RFQ NA
05/03/20
64
Floatdene International Limited
Purchase of 4 Electrolyte Analyser Starter packs NA NA SSS NA
11/12/20
65 MOD Chartered Archtects
Consultancy services for the design, supervision and construction management for the expension of Malawi College of Health Sciencies-Blantyre Compus
01/08/2008
01/09/2008 NCB NA
03/10/20
66
Norman & Dawban (Mw) Limited
Consultancy services for the design, supervision and construction management for the expension of Malawi College of Health Sciencies-Zomba Compus
01/08/2008
01/09/2008 NCB NA
03/10/20
67 Zingano and Associates
Consultancy services for the design, supervision and construction management for the expension of Malawi College of Health Sciencies-Lilongwe Compus
01/08/2008
01/09/2008 NCB NA
01/10/20
68
Nangaunozge Building Contractors
construction of maintenance unit and rehabilitation/expansion of four health centres in Salima
14/04/2008
15/05/2008 NCB NA
01/07/20
69
Western Construction Company
construction of a pilot phase of two houses of Nsiyaludzu in Ntcheu District
14/04/2008
15/05/2008 NCB NA
01/07/20
70
Hualong Construction (PVT) Limited
construction of single, two and three storey pharmacology, physiology and biochemistry labolatory blocks, teaching block, day room, animal house.
14/04/2008
15/05/2008 NCB NA
01/07/20
71 Delta Construction
construction of new labolatory with
14/04/2008
15/05/2008 NCB NA
01/07/20
associated site works and services at Kamuzu Central Hospital and extensions to the exisisting labolatory at QECH
72
Kamwaza Design Partnership
Supervision and construction management of Umoyo Housing Program South East Zone
14/07/2007
13/08/2007 NCB NA
28/09/20
73
Kamwaza Design Partnership
Supervision and construction management of Umoyo Housing Program South West Zone
14/07/2007
13/08/2007 NCB NA
28/09/20
74 DDC Designs
Supervision and construction management of Umoyo Housing Program Central East Zone
14/07/2007
13/08/2007 NCB NA
28/09/20
75 DDC Designs
Supervision and construction management of Umoyo Housing Program Central West Zone
14/07/2007
13/08/2007 NCB NA
28/09/20
76 DDC Designs
Supervision and construction management of Umoyo Housing Program Central West Zone
14/07/2007
13/08/2007 NCB NA
28/09/20
77 MD Initiative
Supervision and construction management of Umoyo Housing Program Northern Zone
14/07/2007
13/08/2007 NCB NA
28/09/20
78
Kamwaza Design Partnership
Supervision and construction management for BEmoaC health centres in the Southern Region
09/09/2007
08/10/2007 NCB NA
23/11/20
79 DDC Designs
Supervision and construction management for BEmoaC health centres in the Central Region
09/09/2007
08/10/2007 NCB NA
23/11/20
80 MD Initiative
Supervision and construction management for BEmoaC health centres in the Northern Region
09/09/2007
08/10/2007 NCB NA
23/11/20
81 Chanika Building Company
Construction & Painting works
17/07/2004
24/07/2007 RFQ NA
26/07/20
82 Plus Ten
Supply and delivery of Building materials.
17/07/2004
23/07/2007 RFQ NA
26/07/20
83 Vhaima Building Company Fitting tiles
17/07/2004
25/07/2007 RFQ NA
26/07/20
84 GlobeComputers
Purchase of Laptop computers
07/08/2007
14/08/2007 RFQ NA
16/08/20
85 MACS Agencies
Supply and fitting of carpets
18/08/2007
25/08/2007 RFQ NA
30/08/20
86 MACS Agencies
Supply and fitting of carpets for PAM offices
17/07/2008
24/07/2008 RFQ NA
04/08/20
87 Valentines Investment
Construction of Water Kiosks
16/08/2007
23/08/2007 RFQ NA
30/08/20
88 Design Printers
Printing of OPD Register
17/11/2008
24/11/2008 RFQ NA
25/11/20
89 Hub Media Group
TV/Radio documentries
17/11/2007
24/11/2007 RFQ NA
27/11/20
90 Hub Media Group Gingles production
21/10/2008
28/10/2008 RFQ NA
31/10/20
91 Venus Printing
Printing of Desk calenders
13/09/2007
20/09/2007 RFQ NA
21/09/20
92 Multiple Suppliers Vehicle tyres Various Various RFQ NA Various
93 Various dealers/garages Service of Vehicles Various Various RFQ NA Various
94 Various dealers/garages Service of Vehicles Various Various RFQ NA Various
95 HH Wholesalers
Procurement of hardware materials
01/10/2008
08/10/2008 RFQ NA
10/10/20
96 Far Distribution Company
Procurement of heavy duty bicycle
18/09/2007
17/10/2007 NCB NA
05/12/20
97 Toyota Malawi
Procurement of 15 Nos. Motor Vehicle Ambulance
23/06/2008
22/07/2008 NCB NA
07/09/20
PARTEC LtdService contract for CD4 Count Machine DC NA
Medical Consultants AfricaService contract for Phillips Machine DC NA
Sitbec Construction Company
Construction of Perimeter Fence at CHSU NCB NA
Sitbec Construction Company
Renovation and Extension of National TB Ware-house at Central Medical Stores NCB NA
Hualong, City
Rehabilitation/replacement of Zomba Central Hospital ICB NA
Winiko Theatre Co.Consultancy on cholera campaign DC NA
Compubyte Electronics Ltd
Inventory for IT equipment in the Ministry of Health RFQ NA
Pabu Building Construction
Rehabilitation of Mzuzu Central Hospital NCB NA
AMPROC
Consultancy to undertake Procurement Audit ICB NA
Hub Media GroupConsultancy for TV Documentary RFQ NA
Lot 1. Tayub Lots 2 & 4 Blockbuster Lot 3. Shire Ltd
Procurement of Office Furniture & Equipment NCB NA
Reticia, Marsy, Tregia & International Agencies
Procurement of various stationery items NCB NA
Business Machines Ltd
Tender for Procurement of IT Equipment for Cost Centres ICB NA
Lot 1. IT Centre Lot 2. Gestetner Ltd
Tender for Procurement of IT Equipment for EPI NCB NA
EPOS Health Consultants
Consultancy on Financial Management Coaches ICB NA
Skywaves Mw Ltd
Tender for procurement of eye equipment DC NA
1. Toyota Mw 15 ambulances 2. HTD Ltd 5 Trucks (7 ton) 3. Mike Appel & Gatto Ltd 3
Procurement of Ambulances, Double Cabs, Heavy Trucks and Station wagons ICB NA
D/Cabs and 4. HTD 10 Station Wagons
Vital Signs Ltd
Procurement of spare parts for a Gambro AK 95 Dialysis Machine at Kamuzu Central Hospital DC NA
Mike Appel & Gatto LtdSupply and Delivery of 3 No. D/Cabs. LIB NA
HTD Ltd
Supply and Delivery of 10 4 x 4 Station Wagons LIB NA
Toyota MalawiSupply and Delivery of 15 Amblances LIB NA
HTD LtdSupply and Delivery of 7-5ton Trucks LIB NA
Action Plan to address cases of mis-procurements. An Action to address cases of misprocurements raised in the 2006/2007 procurement audit report was developed and circulated to all SWAp Pool Partners. The action plan was executed accordingly.
Key Undertakings to address challenges/way forward
Filling all vacancies for procurement officers with appropriately qualified officers
Increased provision of training in procurement management
Provision of adequate financial resources to the Procurement Unit in the Ministry of Health to intensify its training and supervision activities in all the cost centres in the health sector.
Controlling officers to identify focal points (procurement teams) from departments to act as liaison persons on preparation of procurement plans. Preparation and submission of procurement plans to become a management function. Procurement plans to be linked to the budget cycle, in particular to the cash flow.
All Pool Partners to align with the agreed SWAp procurement procedures in the implementation of procurement activities which they finance.
Need for the Ministry of Local Government to ensure that all districts submit their reports on their procurement activities. The Ministry does not have systematic information on the performance of district based contracts since reports from the districts are not available.
Development of a procurement data base system for management of procurement function.
CHAPTER 3. CHALLENGES AND WAY FORWARD
While the sector made remarkable progress in many key result areas of the POW, a number of challenges continued to hamper progress in other areas. The key challenges faced during the reporting period could broadly be grouped into four categoriesPolicy development The ministry faced some challenges in policy development partly as a result of capacity and partly as a result of circumstances beyond control of the MoH. Key policies that have not moved with at the anticipated pace are the National Health Policy and National Health Act, The transport policy, the SWAp MoU and Cham/MoH MoU. Other policy related documents that have not progressed as expected are the PPP guidelines,DHMT management manual and revision of costings for SLAs.While some policies delayed as a result of capacity problems many policies have been completed or were completed some time back but still remain un launched. Progress on reforms which depends much on new policies slowed down because decisions have to be made out side the domain of the MoH.Implementation of policyWhile recognizing the challenge of making policies, it is also noted that there were challenges related to full implementation of some policy decisions. A typical example is the failure to implement the locum guidelines and the consequent failure to control various practices at lower levels of the ministry. A number of policies have either not been fully implemented of are partly being implemented eg the capital investment plan which is not being followed. Reasons for the problems related to this are capacity and financial constraints. Monitoring policy implementationMany policies have been developed but monitoring framework for implementation of those policies are not in place as part from few departments most departments neither use HMIS nor have their own means of checking that policy is being implemented. The environmental section for example has not yet put a mechanism to check progress implementation of various policies developed in that department. This lack of monitoring created a two fold effect .The first one being that the departments do not have targets and therefore prepare plans that can not be linked with progress on the ground. The second one is that reporting has been a continuous challenge for most of them since they have no targets
Procurement Challenges
In adequate training and supervision of the procurement function in the health sector due to lack of resources.
Capacity constraints at all levels in procurement in the health sector. Established positions not filled at the DHO level.
Budget overruns affecting execution of the procurement plan during the 2008/09 financial year.
Delays in submission of specifications by user departments affecting implementation of the 2009/10 procurement plan and splitting of tenders
Numerous unplanned and urgent procurements not in the approved budget and procurement plan overloading the already overstretched procurement unit, leading to compromises on procurement procedures and overcrowding of the more important planned procurement activities.
Poor coordination amongst the players (user department, procurement unit and accounts department) involved in the procurement process leading to delays in procurements, delays in payment to suppliers and procurement of wrong items.
Lack of linkage between the procurement plan and cash flow delaying payment to suppliers.
Communication and coordination
The last challenge has been communication / coordination challenge. What mostly eats up most of the time of senior staff in the ministry are meetings, some of them scheduled others not. Beside this there are also a number of workshops happening within the ministry that require full participation of the same staff who are to drive key processes in the MoH. The zonal health support office has not yet been fully utilized to assist MoH in linking with the districts
Way forwardFinalise the policiesand lauch policiesAssist in Implementation of policiesMonitor policy implementation through various meansCoordinate activities of the health sectorStrengthen use of TWG to assist in identifying solutions to bottlenecks in implementation
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