When he was a student at the University of Chicago, Dr. Hastings Kamuzu Banda haboured ambitions of returning to Nyasaland and to devote much time to help people in education and health even if it required doing so in the government service, and was quoted as stating that: \u201cMy whole aim is to help my country\u201d.<\/p>\n
That dream came true when he returned to Nyasaland on July 6, 1958 in order to play a crucial role in the break-up of the Federation of Rhodesia and Nyasaland, and became Malawi\u2019s first president after the country attained self-rule.<\/p>\n
Kamuzu was renowned for his humour, oratory and searching and analytical approach to social, political and economical issues.<\/p>\n
If improving the inherited colonial health delivery system was the yardstick with which to measure his success under the Malawi Congress Party-led (MCP) government, then, the former life president contributed immensely.<\/p>\n
No wonder that he was a persuasive interpreter of the policies of his government that improved life of ordinary people. The quest to help the country stemmed from poverty and diseases such as malaria and diarrhoea that were prevalent in the villages.<\/p>\n
Missionaries\u2019 contribution to medical services<\/p>\n
It is well known that in colonial times medical services did not reach people in the remote parts of the country.<\/p>\n
There were disparities in the hospital services such that there was one bed per 1 000 Nyasas compared to eight per 1 000 Europeans. People often travelled long distances in order to access medical services.<\/p>\n
Much of the health infrastructure existed in places where the missionaries had established churches, schools, hospitals and dispensaries, and were mainly established by the Church of Scotland in Blantyre, the Free Church of Scotland in Livingstonia, the Dutch Reformed Church Mission in Mvera and the Universities Mission to Central Africa at Likoma Island on Lake Malawi.<\/p>\n
The mission trained staff comprised Africans and Europeans. It looked that during that era, there was a great deal of diverse Christian networks, and that the British connection was just part of it.<\/p>\n
Medical professionals such as doctors and nurses from the missionaries were among the most mobile individuals who connected modern professionals with older and more far-reaching missionary networks and groups.<\/p>\n
Though their primary practical function was to secure the health of their fellow missionaries, they found themselves in a situation in which they had to train Nyasas after noting that there was a great deal of illness in the villages, especially among children.<\/p>\n
They felt that training of medical personnel was one of their best contributions to the medical services and to the population of the country. But training of nurses evolved after an educational system was developed according to Western standards and different syllabuses were formulated. Later examination started to be administered. But that was not enough.<\/p>\n
Inherited colonial medical system <\/strong><\/p>\n The situation changed when Malawi\u2019s attaining of independence on July 6, 1964 brought with it stocktaking and reassessment of the health system inherited from the Nyasaland government.<\/p>\n Kamuzu embarked on an exercise not only to promote collaboration and enhance the quality of mission hospitals but also the crucial work of the Malawi Government.<\/p>\n The goal was to rationalise the inherited colonial medical system while improving the population\u2019s access to high-quality medical as well as health services.<\/p>\n Thus, two years after independence, the Malawi Government under \u201cthe wise and dynamic leadership of Kamuzu\u201d decided to promote such developments with the creation of the Private Hospitals Association of Malawi (Pham) in 1966 later renamed the Christian Hospitals Association of Malawi (Cham).<\/p>\n Cham with its hospitals and health centres coordinated a large non-profit healthcare system. The belief was that the mission boards and the colonial government often failed to commit appropriate financial and human resources in the health sector.<\/p>\n With yearly subvention from Malawi Government, Cham hospitals and its health centres such as Katema Health Centre in Mangochi South West provide a proportion of its services at variable charges.<\/p>\n Economy, hospital projects and donor confidence <\/strong><\/p>\n Economically, Kamuzu aspired to make Malawi to be a net exporter of agriculture products and producing enough food for itself.<\/p>\n Both agriculture and industry sectors were not separated from each other. But the former\u2019s economic influence increased agriculture products.<\/p>\n As a consequence, the 1970s was a relatively good economic period during which Malawi had a fairly high growth domestic product (GDP) and investment growth. Buoyed by that economy and donor confidence, Kamuzu with his government built modern district hospitals such as Mangochi, Mchinji, Chikwawa, Karonga, Rumphi, Dedza, Mulanje, Ntcheu and Kasungu.<\/p>\n These were supplemented by the construction of health centres and dispensaries. The community also erected theirs in many localities either during youth week programme or self\u2013 help projects, and government furnished them with drugs, equipment, furniture and medical staff.<\/p>\n However, there was excessive recourse to foreign loans to finance some of the prestige projects. That was evident in the mid 1970s when the country began to undertake significant commercial borrowing initially to finance development programmes.<\/p>\n Thus, commercial borrowing increased from less than two percent in 1976 to more than 24 percent in 1980. International organisations replaced bilateral donors as the main source of foreign funding with the International Development Agency (IDA) as the multilateral creditor.<\/p>\n Kamuzu Central Hospital, which was opened on November 4, 1977 by Kamuzu, and district hospitals were many prestige projects undertaken with foreign funding. With such developments on the ground, Malawi was perceived by donors as a relatively effective user of aid.<\/p>\n Nursing college and medical school supplementing mission-trained nurses <\/strong><\/p>\n Though in the 1980s fiscal management and economic conditions worsened partly triggered by the civil war in neighbouring Mozambique, debt and poor domestic policy, Kamuzu did not lose sight of human resource development to strengthen the performance of the health system for the effective delivery of the health services.<\/p>\n The share of health in development expenditure on average doubled between 1977 and 1988 and then 1989 and 1993. That occurred despite the much-touted structural adjustment loans and conditions in 1980s.<\/p>\n Thus, under the MCP regime, government established Kamuzu College of Nursing in Lilongwe and College of Medicine of the University of Malawi in Blantyre to increase number of nurses and doctors.<\/p>\n The latter project started in 1986. By 1991, the college was fully established with the first group of doctors getting first trained in Great Britain before completing final year in Malawi and graduating in 1993.<\/p>\n Previously, doctors were trained in South Africa, Great Britain and Australia. Archive records indicate that between 1899 and 1927, the missionaries employed one doctor who travelled between hospitals that were in practice run by a nurse.<\/p>\n The doctor often practised medicine part-time. As for nurses, most were recruited from Great Britain. But the establishment of the nursing and the medical colleges under Kamuzu increased local training and availability of nurses and doctors.<\/p>\n In a way, the nursing college supplemented nurse training courses that started to be organised independently in the mid 1920s at mission hospitals in Khondowe in Rumphi, Mvera in Dowa, Mlanda in Ntcheu and Nkhoma in Lilongwe.<\/p>\n Indeed, Malawi, under Kamuzu\u2019s rule, made significant strides to improve the health standards of the country. Power cuts never interrupted health services. Drugs were not in short supply. Theft of medical drugs and other supplies by medical workers were unheard of. Patients were not crammed on mattresses on the floor. Bogus doctors never infiltrated government hospitals.<\/p>\n There was constant supervision of the medical personnel. Training of medical personnel was frequent and adequately funded. Most found employment in government hospitals, rural health centres and clinics after finishing courses. As a professional doctor, every year on December 25, Kamuzu would visit a district hospital to cheer the sick and talk to medical personnel.<\/p>\n Health care 18 years after Kamuzu\u2019s death <\/strong><\/p>\n By the time Kamuzu was removed from power on May 18, 1994 during elections and even 18 years after his death on November 25, 1997, the health system has worked very well with regular supply of drugs, recruitment and training of medical personnel.<\/p>\n That has enabled hospitals such as Kamuzu Central Hospital to continue serving as a tertiary-care hospital in the centre while providing primary and secondary-care services, in part on an account that Lilongwe does not have a district hospital.<\/p>\n In short, Kamuzu laid a strong foundation of development which may be used for time to come.<\/p>\n No wonder that the Bingu wa Mutharika administration started off from where he had left as exemplified by the rehabilitation of Bwaila Bottom Hospital and the construction of Thyolo, Nkhata Bay and Nkhota Kota district hospitals.<\/p>\n Previously, people in Thyolo District relied on Malamulo Mission Hospital which has been providing health services since 1902. The construction of the district hospital has enabled the majority of patients to access medical services under their own means. The Peter Mutharika administration\u2019s plans are afoot to construct a national cancer centre, Dowa Rural Hospital and Lilongwe District Hospital which will ease the pressure being exalted on Kamuzu Central Hospital.<\/p>\n Currently, about 85 percent of the population now lives within 10 kilometers (km) of a health facility.<\/p>\n Thus, after Kamuzu\u2019s death, much has improved in the provision of healthcare services arising from the good foundation he laid down at the very beginning upon attaining independence.<\/p>\n For instance, there has been reduction in infant mortality rates from 76 per 1 000 in 2004 to 656 per 1 000 in 2002 while child mortality rate has reduced from 133 per 1 000 in 2004 to 112 per 1 000.<\/p>\n However, that improvement is dwarfed by the current maternal mortality rate of 574 per 100 000 live births in 2014, which is above the Millennium Development Goal (MDG) target of 155 per 100 000 live births. Even cases of malnutrition have greatly improved though they still remain a scare in the face of hunger as was the case in the 1980s.<\/p>\n Are centre port released by the United Nations Children\u2019s Fund add credence to cases of children being admitted either with severe or acute malnutrition in the country\u2019s health centres.<\/p>\n Challenges in health services <\/strong><\/p>\n However, there are still gaps resulting in a poor referral system in districts that do not have a district hospital.<\/p>\n Congestion in central hospitals is a major problem. That is compounded by inadequate funding in the health sector budget allocation, which has dropped significantly from 11 percent in 2013\u2013 2014 to eight percent in 2014\u20132015 fiscal years.<\/p>\n With a myriad of problems , notably, power cuts interrupting health services, water disconnections to hospitals, shortage of drugs and other essential medical supplies that are orchestrated by some pharmacists in concert with members of staff, poor supervision and support services, shortage of health workers, and other signs of a deteriorating health service that never existed under Kamuzu, the health sector is faced with an expenditure whose resource envelope is neither particularly efficient nor equitable.<\/p>\n When compared to other hospital standards, the resource envelope is very small to make an impact on the health delivery system.<\/p>\n However, international organisations such as ShareHope through a collaborative humanitarian partnership among the Coca\u2013Cola Africa Foundation, CitiHope and MedShar e have made timely donations of pharmaceuticals, medical supplies and equipment to some hospitals in Malawi to strengthen the quality of health services as outlined in the health policy, strategy and programme formulation of the Ministry of Health. But government is grappling with measures to stem the tide of theft of medical drugs in its hospitals which at times is orchestrated in connivance with patients.<\/p>\n As Malawians cerebrate 52 years of independence on July 6, 2016, let us remember Kamuzu and his government that provided sufficient financial and human resources in the health sector now pervading the country.<\/p>\n His ambition and reputation for honesty enabled him to be a mature political figure whose ideas were transformed into many prestigious projects in Malawi. Being a wise man, he knew how to enforce with temper while conciliating with dignity.<\/p>\n","protected":false},"excerpt":{"rendered":" When he was a student at the University of Chicago, Dr. Hastings Kamuzu Banda haboured ambitions of returning to Nyasaland and to devote much time to help people in education and health even if it required doing so in the government service, and was quoted as stating that: \u201cMy whole aim is to help my […]<\/p>\n","protected":false},"author":3,"featured_media":27488,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-27487","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/posts\/27487","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/comments?post=27487"}],"version-history":[{"count":1,"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/posts\/27487\/revisions"}],"predecessor-version":[{"id":27489,"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/posts\/27487\/revisions\/27489"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/media\/27488"}],"wp:attachment":[{"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/media?parent=27487"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/categories?post=27487"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/archive.times.mw\/index.php\/wp-json\/wp\/v2\/tags?post=27487"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}