The DFID-funded Malawi Health Sector Programme, Technical Assistance (MHSP-TA) is managing and delivering a four year programme to enhance the implementation of the 2011 – 2016 Health Sector Strategic Plan and support planning for its second phase.
One focus of the programme is on accountability and health efficiencies at all levels. Informed by recent studies on health efficiencies and drug leakage our work has a strong emphasis on reducing commodity losses, including essential drugs.
We have worked with the national Ministry of Health using an adaptive and integrated approach to prevent drug theft and supported a newly established Drug Theft Investigation Unit (DTIU). We have helped the DTIU to undertake drug theft investigation audits across nine districts encompassing 47 health facilities and four district health offices. These have led to prosecutions which act as a strong deterrent, and we hope will lead to a reduction in drug theft.
Our programme has also supported District Council Health and Environment Committees in eight out of 15 focus districts and trained 419 District Councillors across the country on gender and disability issues. We have supported district health management teams to develop their own health efficiencies action plans for strengthening accountability for health resources.
We are strengthening governance and accountability at community level through Health Centre Advisory Committees (HCAC). Substantial losses of essential medical supplies and drugs occurs at health centre level in Malawi, hence our interest in working with HCACs to strengthen drug accountability.
A HCAC is a group primarily of volunteers who live within the catchment area of their local health centre. Representation includes women, youth, people with disabilities, hard to reach communities and also includes service providers. They were set up as a mechanism for enhancing community participation in health. We are working to support selected HCACs to improve accountability and oversight on how health services are being delivered and to offer solutions when challenges arise.
HCAC’s membership and duties at health centre level have never been formalised or approved. We are working with a local civil society organisation, the Malawi Economic Justice Network to train and mentor 11 HCACs in Rumphi, Mulanje and Mwanza districts.
One of our aims is to develop a Ministry of Health endorsed terms of reference, curriculum and training tools which can then be used by other organisations working with HCACs across Malawi.
A Malawian research NGO, Research for Equity and Community Health (REACH) Trust, is also conducting an evaluation of the initiative which will help identify successful elements of the approach for scale up in other districts. This initiative is at the forefront of developing ideas on how to strengthen the District Health System and promote stronger accountability and transparency mechanisms– a key part of the Ministry of Health’s reform agenda. Our work across national, district and community levels has so far stimulated greater coordination and linkages for accountability, leading the Ministry of Health to nominate MHSP-TA as the lead partner on community initiatives to improve health service quality.