For the most part, Malawi is a rural society: with 81% of the population living in rural areas. The number of doctors here is still very low and the population has to rely on health centres and district hospitals for their primary care. High-quality training for doctors with broad expertise is crucial. This would also benefit their long-term sustainable development.
The Department of General Practice at Kamuzu University of Health Sciences (KUHeS) has been working with Dioraphte since the end of 2015. This has established a solid foundation on which to train family physicians, on a par with our general practitioners. Since then the university’s international network has grown larger than ever before, in terms of affiliated donor organisations and many international partnerships. Nevertheless, investment is still needed to ensure that good basic healthcare remains available to Malawi’s most disadvantaged rural residents.
On-site training
One activity Dioraphte supports is the expansion of the postgraduate training programme for family medicine. That training takes place at Mangochi District Hospital and the Nkhoma Mission Hospital. Over four years, doctors-in-training work at different departments and outpatients’ clinics. After graduation, they will be able to manage healthcare services in the district. Recently a plan was made to dispatch the students to South Africa for six weeks for additional internships. Another ambition is the expansion of the course to a third location: Neno District Hospital. On top of that, a recent step was the development of palliative healthcare training, unprecedented in Africa.
Lobbying to ensure continuity
In the meantime, it is crucial to safeguard the long-term viability of basic healthcare in rural areas. One important commitment – partly funded by the Norwegian government programme NORHED – is advocating for better healthcare in Malawi. This is achieved partly by engaging local stakeholders to do relevant research and to attend (inter)national conferences, as well as through participation in the Human Resources for Health Working Group in capital Lilongwe. The advocacy work particularly addresses the vital role family doctors play in district hospitals. The ambition: to increasingly assign locally trained family doctors a key role in the development of primary health care in Malawi.
Building on a solid foundation
‘Training for family doctors was launched in 2011. Dioraphte joined up in 2015, just as I was going to Malawi. Their contribution came at a critical time. We had the funds to set up the programme, but not to hire the staff. This was necessary for us to develop further, towards the strong training programme we have today. Our long-term relationship ensured continuity. And because we were able to keep expanding, we managed to bring in other sponsors. This has created a steady stream of well-qualified doctors who, in turn, continue to train new recruits. This will eventually enable primary health care in Malawi to become increasingly more self-sufficient.’
Barbara Swarthout, tropical physician and family physician, working in the Department of Family Medicine, KUHeS (formerly College of Medicine)