Reducing child morbidity and strengthening health care systems, Malawi

Between 2003 and 2007, Health Partners Southern Africa (HPSA) and Health Partners International (HPI) facilitated the decentralisation of health management and implementation of hospital autonomy in Malawi as part of a USAID funded project, led by Management Sciences for Health.

At the start of the project, there was only a rudimentary ‘road map’ for hospital autonomy; there was no shared understanding by stakeholders and management systems were poor. The Queen Elizabeth Central Hospital was overwhelmed by patients coming directly to the hospital, having bypassed their nearest health facilities.

Working the Ministry of Health at district and national levels and the Queen Elizabeth Central Hospital and other stakeholders, the project assisted the Ministry to establish a policy and statutory framework for hospital reform, formulate a strategic framework and an implementation plan for hospital autonomy and systematically strengthen all management systems.

Strategies were informed by qualitative surveys investigating why people bypass lower level health facilities in favour of tertiary facilities. A key focus was on improving the quality of care at district level through training district-level clinicians and streamlining and standardising the process of referring patients between districts and central hospitals.

HPSA’s and HPI’s support facilitated key results including:

  • A comprehensive policy and legislative framework to help implement hospital reform including the development of the hospital reform policy (Draft National Policy on Hospital Reform), the Malawi National Health Bill for Hospital Autonomy and a draft Trust Constitution for Autonomous Hospitals;
  • Improved financial management through the implementation of strengthened management systems for annual business planning, finances, revenue and accounting;
  • Rationalised organisational structure, staff establishment, administration of human resources, support services and electronic pharmaceutical inventory control for tertiary hospitals to facilitate general management;
  • Effective referral feedback mechanisms;
  • Improved clinical management of cases at district-level prior to referral;
  • Quick, reliable and efficient communication between referring clinicians and referral institutions (including the standardisation of referral forms);
  • Strengthened Health Management Information System (HMIS) to facilitate quarterly performance reviews; and
  • A draft White Paper on Health to address emerging issues such as decentralisation, the changing role of government, Sector Wide Approaches (SWAps) and the control of health related research.