Global Health Preparedness Project in Malawi
The Norwegian institute of Public Health (NIPH) focused initially on enabling the national ownership of Public Health Institute of Malawi (PHIM) to effectively mitigate public health threats. Global Health Preparedness Programme (GHPP) activities focused on strengthening the national Integrated Disease Surveillance and Response (IDSR) system, and several IHR assessment activities.
Republic of Malawi
Malawi is a landlocked country in South-Eastern Africa, and neighbouring countries of Zambia, Tanzania, and Mozambique. According to the UN Human development index, Malawi is among the least developed countries with plenty of inherited challenges. The Malawian economy has been greatly challenged with limited natural resources, rapidly growing population and their heavily dependence on agriculture. The country is divided into 28 districts and five health zones distributed over three administrative regions, namely the Northern, Central and Southern Regions.
Malawi has been a long-standing global health partner for Norway. In a fundamental step, NIPH in collaboration with IANPHI and national authorities in Malawi supported the development of the Public Health Institute of Malawi at the planning phase of GHPP activities in Malawi. Within the following lines, we describe the development, achievement, and key learning lessons from the GHPP in Malawi. The GHPP was designed to contribute to global efforts of fostering the implementation of the International Health Regulations (2005) (IHR) worldwide.
The Public Health Institute of Malawi (PHIM) was established in 2012 and is not yet a legal entity, but formally part of the Ministry of Health. It has been structured on three units – the Epidemiology Unit, the Research Unit and the National Reference Laboratory and receives its core funding through the annual budget of the Malawian Ministry of health.
Communicable diseases like Human Immunodeficiency Virus (HIV), acute respiratory tract infections, diarrhoeal diseases, malaria, tuberculosis, and vaccine preventable infections are common causes of death and illness in Malawi. In addition, the prevalence of non-communicable diseases is increasing in the country.2
Developing a national ownership of GHPPs activities in Malawi had been a priority. NIPH therefore seconded a professional expert to PHIM for a two-year period from 2015. This was substituted with a collaboration agreement signed with Norwegian Church Aid (NCA) in Malawi and lasted until 2020. NCA administered funds spent in the project in Malawi, as well as employed local positions.
Experts at NIPH assisted Malawi in conducting their first national assessment of the IHR in 2015. The assessment demonstrated that Malawi did not yet have all the core capacities in place and identified areas that needed to be addressed. This led to prioritisation of the intended activities of GHPP which later became a part of the NIPH–PHIM collaboration. A Joint External Evaluation (JEE) was later conducted in 2019, which was supported financially by WHO and NIPH. The results of the evaluation demonstrated that while Malawi can point to success in improving health outcomes, many technical capacities remain under development.
Following the success of the JEE, a full-scale simulation exercise (SimEx) of Ebola was conducted. In addition, technical and financial support was provided during responses to several infectious disease outbreaks, including cholera and anthrax, as well as through participation in several national committees, including the National Rabies Task Force. GHPP’s extended activity list included building national competencies of disease surveillance and outbreak response via implementation of the Integrated Diseases Surveillance and Response (IDSR) and Field Epidemiological Training Programme (FETP). These activities have been playing vital role in the national strategy of managing the pandemic in Malawi. GHPP also had tailored technical and financial support for a study on COVID-19 prevalence and knowledge led by I-TECH:
- Study: SARS-CoV-2 Prevalence in Malawi (link to scientific paper, November 2022).
End user experience
- Enhancing the national implementation of IHRMEF:
- Conducting its first JEE
- Developing National Action Plans for Health Security (NAPHS)
- Conducting simulation exercise of Ebola outbreak
- Managing an outbreak of anthrax within the animal sector (Hippopotamus) and probably preventing a spill over to surrounding communities.
- Self-reliance or developing our national competences is an invaluable hallmark of our collaboration. NIPH had supported financially and technically the following activities:
- Training and hiring two public health specialists as communication and surveillance officers.
- Frontline FETP training was conducted for seven trainees for a period of two cohorts.
- One Malawian delegate was enrolled for two years master’s programme of Field Epidemiology in South Africa.
- COVID-19 prevalence study was conducted jointly with I-Tech on the prevalence of active SARS-CoV-2 infection in communities and health care workers.
- Exchanging expertise with NIPH has empowered the national abilities to manage the ongoing pandemic of COVID-19.
"Our collaboration with NIPH was crucial for us to develop our abilities and capacities to handle COVID-19 pandemic." – Dr Evelyn Banda – team leader at Public Health Institute of Malawi.
- Every country has its own challenging dynamics. To overcome these challenges effectively and advance the national implementation of IHR core capacities, a strong and long-term peer to peer partnership is needed.
- Developing technical competences on a national level is fundamental, however it could be at risk of fragmentation without a solid organisational framework in the form of a national public health institute like PHIM.
- Engagement with partner country in conducting IHRMEF activities such as SimEx, JEE, and After-Action Reviews proved to be worthy to exchange national expertise of implementing IHRMEF.