Malawi Health Equity Network (MHEN) END OF YEAR REPORT 2003 Abbreviations BLM: Banja La Mtsogolo CAMA: Consumers Association of Malawi CHAM: Christian Health Association of Malawi CHESSORE: Center for Health, Social Sciences Research CHWGH: Community Health Working Group on Health DfID: Department for International Development EQUINET: Regional Network for Equity in Health in Southern Africa GEGA: Global Equity Gauge Alliance HST: Health Systems Trust MHEN: Malawi Health Equity Network MPRSP Malawi Poverty Reduction Strategy Paper NDI: National Democratic Institute for International Affairs SADC: Southern African Development Community Foreword The Malawi Health Equity Network (MHEN) has now completed four (4) years of work in Malawi. The first years have been both turbulent and enjoyable as we all set to see the baby grow. Malawi’s infant mortality rate stands at about 104 deaths per 1,000 live births. The MHEN baby could have died were it not for the nourishment that it obtained from both local and international partners. Of particular mention are been the National Democratic Institute for International Affairs of the UK government, the National Democratic Institute for International Affairs, the Ministry of Health and lately Ireland Aid. It is not only the infant mortality that is unacceptably high in Malawi but also the maternal mortality and the under-five mortality. We therefore wish to ensure that our baby, the MHEN at least reaches the age of five. And there are indications that we are going to succeed. Our relationship with our main partner NDI has grown from strength to strength and so has the relationship with the National Assembly and the Ministry of Health. The media has been an ally in our advocacy work. Health equity is about attending to the unfair, avoidable differences in health status and health care access among people. We, at the MHEN wish to assure all Malawians that we will not rest until these injustices that we see in the health sector are removed completely. If that would not happen, such would give us reason to the MHEN to continue existing. Dr. Adamson S. Muula Chair Malawi Health Equity Network February 2004 Introduction Malawi Health Equity Network has completed four years since it was established as a full network in 2000. During the past few years the Network has gone through a significant developmental process which has witnessed it claiming an important public health advocacy position. The present report represents activities, progress, challenges, and way forward for MHEN. Background of MHEN The Malawi Health Equity Network (MHEN) is a Civil Society Organization working towards the promotion of Health for all people in Malawi. The Network comprises interested civic and community-based organizations and individuals who work to supplement government efforts in ensuring that there are better quality health care services in Malawi. MHEN was formed in 2000 when the Malawi Health Advocacy Network joined with Health Equity Network of Malawi. The main objectives for the existence of MHEN are: to assist government in its effort to ensure wide access to essential drugs by the communities, to conduct relevant research pertaining to equity in health, to advocate and maintain a data base of information on equity, contribute to the formulation and monitoring of the National Budget, provide relevant health information to the Parliamentary Committee on Health and Population, advocate for Patients and Health providers’ rights and responsibilities and ensuring that there is equity in the availability and accessibility of health interventions, especially against HIV/AIDS and health human resources. MHEN Mission Statement Malawi Health Equity Network (MHEN) is an independent alliance of Civil Society Organizations and other interested parties promoting equity and quality in health care services for all people in Malawi by influencing policy and practice through research, monitoring, evaluation, advocacy and civic education. Vision All people in Malawi to have access to equitable, quality and responsive Essential Health Care Services by the year 2020 with Malawi Health Equity Network (MHEN) as Malawi’s “Health Equity Watch’’ Programs and Activities in 2003 In the year 2003, MHEN conducted a number of program activities falling under the four major pillars. The pillars are monitoring, networking, research and information dissemination and linking with decision makers. However there were other essential ad hoc advocacy activities that were done as part of achieving the vision of MHEN. Networking Networking is one of the core reasons for the existence of MHEN. This is currently done both at the National and International levels. National Level Networking With support from NDI, MHEN’s membership has been able to meet and share experiences in the health sector as well as finding solutions to some operational problems that individual organizations face in the implementation. The Network managed to hold General membership meetings in Lilongwe every three months during the year. In total five general membership meetings were held. Networking among members also improved tremendously. Members were able to share research results and other information among themselves as well as through the secretariat. MHEN also strengthened its working relations and networking with other networks more especially the Malawi Economic Justice Network, Civil Society Agriculture Network, Civil Society Coalition for Quality Basic Education and the Gender Network. Through networking with the sister networks, the level of interaction and influence towards policy makers has been enhanced. The MHEN also has a email list serve managed by NDI that has played the role of a vehicle for the exchange of health information among its members and other networks in the country. International Level The year 2003/4 saw MHEN improving its links with international and local based organizations and networks in different countries who share the same values as MHEN. More especially MHEN has been actively involved in activities with Organizations like EQUINET, CHESSORE of Zambia, The Zambian Equity Gauge, and Community Working Group for Health (CWGH) Zimbabwe, Global Equity Gauge Alliance, Health Systems Trust, South Africa and many more. Through links and networking with these organizations MHEN has been able to have access to information, share information, and broaden its capacity as well as getting exposure to some international work on health and health equity in particular. It is noteworthy to mention that with support from NDI and other partners, the MHEN and EQUINET organized a meeting of civil society groups from Southern and Eastern Africa in Johannesburg, where the SADC Health Department and parliamentary committees were represented. With support of the NDI, MHEN was also involved in a tour of Eastern and Southern Africa by members of parliament. Two members of MHEN were on the entourage. As a result of this trip, the Parliamentary Committee on Health and Population established a coalition on HIV/AIDS. Monitoring During the year 2003/4 MHEN finalized analyzing Drug Monitoring data that was collected in 2002/3 through 2003/4. The final report from the drug monitoring was presented to the Parliamentary Committee on Health and Population as well as at a National Civil Society workshop that was held in Lilongwe organized by the Malawi Economic Justice Network. The results were also submitted to the Ministry of Health as well as some donor community members. A press release was also produced supported by a feature story in one of the local papers and the Public radio (Malawi Broadcasting Corporation.) As a result of the report the parliamentary Committee also conducted drug/Public Health facilities monitoring in some government hospitals across the country. The Parliamentary Committee on Health and population later presented their findings to the National Assembly. Malawi Poverty Reduction Strategy Review As part of the monitoring initiative the Malawi Health Equity Network was also involved in the MPRS review together with the Ministry of Economic Planning and Development and the sister networks (Malawi Economic Justice Network, Civil Society Agriculture Network and the Civil Society Coalition for Quality Basic Education).MHEN worked under the working group of Health and Nutrition. The process is still on going. Research During the year the Network conducted a number of research activities that were aimed at improving the advocacy capacity of the network. The research activities were done by members as well as secretariat staff. Below some of the research works that were commissioned: 1. Research on the Turn-over of Registered Nurses in Malawi. The objective of the research was to find out how many registered nurses are still working in the Public Service and the type of work they are actually doing in the hospitals, reasons why they are still working in the public sector as well as probable incentives to retain them. The study was conducted in all three regions across the country. 2. Research on the Problems and Prospects of Implementing Anti-retroviral Therapy in Malawi. The objective of the research was to identify probable problems that the implementation of the Anti-retroviral Therapy might face. More importantly the survey wanted to bring to light issues of shortage of Human resource, health facilities, economic barriers and other technical problems that can contribute towards the failure of the program to achieve its intended goals. 3. Research on the availability of health information for health workers in Blantyre. This study was carried out to determine how health care workers in Blantyre were obtaining health information. It is argued that the quality of health care services can only be better if adequate and relevant health information is provided and used. This was done with financial support from EQUINET. 4. Research on the living conditions of orphans in Ndirande. There has been an upsurge in numbers of orphans in Malawi. Their living conditions have been little studied. This study was carried out to determine which were the living situations of orphans in the peri-urban area of Ndirande. This study was published in the South African Medical Journal in 2003. 5. Research on ethics and cultural considerations in HIV/AIDS in Malawi. A paper is awaiting publication in Nursing Ethics Journal. This study was carried out with research funds from Ireland Aid. Advocacy During the year, the Malawi Health Equity Network has been involved in some intensive advocacy campaigns through the local Media, workshops and meetings with different stakeholders. Some of the activities were as a response to public announcement from government, problems identified through networking as well as some public concerns. For example the network conducted advocacy work on scaling-up of the Anti-retroviral therapy to the Public sector, the distribution and selling of Insecticide treated Nets; The Network also produced some press statements in the local papers (Daily Times and Nation Newspaper as well as news features on Malawi Broadcasting Corporation on drug shortages in public hospitals, The role of men in Prevention of Mother To Child Transmission of HIV/AIDS, Patients Rights and HIV/AIDS and insurance in the private sector. Links with Decision Makers During the year the Network worked tirelessly trying to strengthen its ties with decision makers. It is normally stated that the strength of civil society organizations lies in their ability to make their voices heard by the responsible officials. If an organization fails to influence and make itself heard, there is no way that it can contribute effectively in sharpening and monitoring government actions as well as contribute effectively to government policies. This is the major reason why MHEN had to concentrate a lot of its energy for the past twelve months in putting itself at a position where it can be heard by all stakeholders. Presently the Network is seriously working hand in hand with the Parliamentary committee on Health and Population, the Ministry of health and Population, Other Ministries and development partners. This is a very big achievement which needs to be sustained and promoted. The links have been complimented with the following recommendable activities that were undertaken: 1. Health Facilities inspections that were done jointly by Parliamentarians (Health and Population Committee) to all regions of the country. 2. HIV/AIDS program visits (NAPHAM centers) that were done also jointly with MPs. 3. International visits to Tanzania, Uganda, and South Africa involving Parliamentarians and Members of the Health Equity. 4. International workshops on HIV/AIDS held in Lesotho 5. SADC Parliamentarian/Civil Society workshop held South Africa. 6. Participation at the launch of the Zambian Equity Gauge 7. Health information exchange meetings with Parliamentarians at Parliament Buildings 8. Involvement in the Sector Wide Approach with the Ministry of Health and Population and the Ministry of Finance. 9. Development of the Patients Rights Charter with the Ministry of Health and Population. These are some of the most notable activities that indicates that MHEN’s working relations with Parliamentarians has improved for the better over the year. Administration Finance Funding to the Network Over the year MHEN has been getting funding for Administrative support from DFID through the National Democratic Institute for International Affairs. The funding was specifically for administrative purposes though at times a request would be made to use some money for advocacy or program support. Previously money was being disbursed directly from NDI as the Network had no bank accounts of its own. MHEN has now opened its own Account number with Stanbic Bank. Program accounts are also prepared on a monthly basis and reported timely according to the requirements of the donor.Apart from this MHEN together with sister networks CISANET, MEJN and CSCQBE obtained funding from Ireland AID to help improve coordination capacity of the Networks with its members as well as improving the networks relations with decision makers. MHEN also received a small grant from Trocaire (Ireland) to conduct a survey on the Implementation of the Anti-retroviral Therapy in Malawi, problems and prospects. The Network also is involved in the planning phase of a project on rural livelihoods and HIV/AIDS that is being implemented jointly with CADECOM of Chikwawa. MHEN is particularly interested in the advocacy part of the project. Accounts During the year MHEN managed to develop its own accounting procedures and Policies. The policies were adopted and currently all MHEN transactions are done following the requirements from the accounting procedures. Constitution For the past years MHEN has been operating without a formal constitution. However during the 2003/4 fiscal year, MHEN managed to develop a constitution to provide the legal direction of the Network. The draft constitution is already in place waiting for adoption at the next General meeting. Secretariat At the beginning of the year with financial support from NDI, MHEN established a secretariat in Lilongwe. The office was established basically to run and be a coordination point for the Network. Three people, Program Officer, Administrative Assistant and an Office Assistant were recruited to run the office. Currently MHEN secretariat is located in Nasah Building, Area 3. Staff Recruitment At the start of the year, MHEN employed two staff members to run its newly established secretariat. The staff were Mr. Chimwenje Simwaka (Program Officer), and late Brenda Maseko as Administrative Assistant. In the course of the year another staff member, Emmanuel Banda was recruited to work as an Office Assistant. Mr. Simwaka left employment of the Network and the network appointed a temporary Program Officer Mr. Paul Msoma take up the post in September. During the same year the Network lost the Administrative Assistant (Brenda) who passed away in September, and her post was filled up by Chipirilo Chonzi who is currently working as an Administrative Assistant. Student Attaché As part of its programs aimed at improving the quality of Students graduating from Malawian Colleges, MHEN engaged the services of a student from the University of Malawi, College of Medicine. Mr. Medson Matchaya worked at MHEN secretariat for two months, between December and January. Mr. Matchaya benefited a lot through exposure to issues of health equity both at the national and international level, as well as writing a proposal and coming up with research ideas. Strategic Plan As a way of improving the capacity of the network as well as providing the direction on the programs and activities the network with support from NDI developed a comprehensive strategic plan for the next three years. The process has helped to shape the operations of MHEN as well as provide the right direction to the Network in order to make it more of an output based organization. The strategic plan also revisited the Vision and Mission of the Network in order to focus on issues that the Network can easily work on without losing direction. Governance and Management Structure MHEN is run by a Steering Committee made up of seven members representing different organizations they work for and individuals serving in their own capacity. The Steering Committee is responsible for governing the operations of the Network, such as providing the general direction of the secretariat and tracking of issues arising in the Network. The Committee also ensures that the operations of the Network are in line with donor requirements. The current steering committee is as follows 1. Dr. Adamson Muula, (Chair person) College of Medicine 2. Dr. Mandela Thyoka, (Vice Chairperson) Queen Elizabeth Central Hospital (Dr. Thyoka has since left for Edinburgh for his studies in Surgery). 3. Dr. Ester Ratsma, Safe Motherhood project 4. Consumers Association of Malawi. 5. Mrs. Lilly Thwindwa, St Johns Nursing School 6. Equi-Tb Knowledge program 7. Mr. Frazer Maseko, College of Health Sciences. Above the steering committee is the general assembly, which is among others responsible for overall policy formulation for the network. The general running of the network is the responsibility of the secretariat headed by the program officer. Two other officers support him. The following are the people working at the secretariat: · Mr. Paul Msoma - Acting Program Officer · Ms. Chipirilo Chonzi - Administrative Assistant · Mr. Emanuel Banda - Office Assistant International Workshops attended · Workshop on Benchmarks, a tool of monitoring Government Policies, held in Siavonga, Zambia · Outcome Mapping, a tool for Monitoring and Evaluation, held in Johannesburg, South Africa · Parliamentary-Civil society workshop in South Africa · The re-launch of the Zambian Equity Gauge, Lusaka, Zambia. · International Educational visits to Tanzania, South Africa and Uganda. · EQUINET Steering Committee Meeting in Johannesburg in November 2003 Challenges Ahead The MHEN has performed relatively well in the year 2003. However, there are several issues that the Network needs to work on to ensure that it continues to be a voice for the people of Malawi in public health issues. These are: 1. diversification of financial sources 2. enhanced collaboration with international and local partners 3. institutional strengthening at the secretariat level 4. encourage stronger linkages between SC and general members. Acknowledgements The MHEN’s work has been facilitated by the support it has received from DFiD, NDI, Ireland Aid, EQUINET and GEGA. Various organizations and individuals have also contributed to the success of the Network. Our work would not have been possible were it not for the support of the Ministry of Health especially Dr. Anne Phoya, Director of Nursing Services and Mr. Nelson Salanje, Director of Planning.