Malawi Site Background

Located in southeastern Africa, the small landlocked nation of Malawi has over 13.6 million people, more than 85 percent of whom live in rural areas. Lake Malawi, the third largest lake on the continent, occupies about one fifth of the Pennsylvania-sized country, with rocky plateaus, narrow valleys, and grassy plains rolling over the rest.

Malawians are among the poorest people in the world. More than three quarters of the population subsists on less than $2 a day, and the U.N. Development Program’s Human Development Index ranks the country near the bottom—166 out of 177 countries.

Poor access to health care, low levels of education, infectious diseases, environmental destruction, and malnutrition plague the country. Infant, child and maternal mortality rates are among the highest in the world. More than one in ten Malawian children dies before reaching the age of five. And Malawian women face a 15 percent chance of dying as a result of complications from pregnancy or childbirth.

Malawi suffers one of the world's highest rates of HIV infection. Many estimates put the infection rate at over 14 percent of the adult population, with rates creeping up to 30 percent or higher in some areas of the country. AIDS kills an estimated 85,000 Malawians each year and has driven average life expectancy down from 46 year to 36. Estimates of the number of Malawian children orphaned by AIDS range from 700,000 to 1.2 million. Many of these children are swept into poverty, unable to attend school and at high risk of becoming infected themselves.                                      

The disease seriously undermines Malawi’s prospects for economic growth and poverty reduction. Workers cannot support their families and children cannot attend school, either because they are infected themselves or are caring for someone who is. Estimates suggest the nation will lose roughly 20 percent of its labor force to AIDS-related deaths by 2020. In 2002, the country suffered a severe famine, in part because the disease kept many farmers from working in their fields. The famine also intensified the problem, as malnutrition and food instability can increase the risk of contracting an infectious disease like AIDS, TB, and malaria, as well as accelerate the progression of these diseases.

Since the late 1990’s a number of national and international projects have attempted to help curb the HIV/AIDS crisis in Malawi. The government launched a National AIDS policy in 1994. Within a decade, nine public facilities were administering antiretroviral drugs (ARVs) to an estimated 3,000 to 4,000 patients. Additional aid to make these drugs more widely available came from international sources such as the Global Fund to Fight AIDS, TB, and Malaria. The government established the National AIDS Commission in 2001 to help implement and manage programs for prevention, testing, and providing treatment. The Commission soon became a focal point in the fight against AIDS, and with a bold new initiative, the Ministry of Health and its partners brought the number of patients on ARVs to 70,000 in 2006.

Although the Malawian government has undertaken an aggressive campaign to scale up testing and treatment, the majority of people who require treatment for AIDS still lack access to lifesaving antiretroviral therapy. A severe shortage of health workers contributes to this. Malawi has only two doctors for every 100,000 people, far below the World Health Organization's recommended minimum of 20 doctors per 100,000. The health worker shortage has been exacerbated by a severe "brain drain." Discouraged by dilapidated facilities, short staffing and lack of essential equipment and medicines, so many Malawian doctors have been lured abroad that more of them now practice medicine in Birmingham, England, than in all of Malawi. Similarly, around 60 nurses are trained every year but at least 100 others leave the country annually to seek employment in other countries. In remote rural areas, lack of transportation, poor roads and rugged terrain prevent many from accessing the resources that do exist in country.

It is in just such a rural area that PIH and the Ministry of Health are now working in partnership with the Clinton-Hunter Development Initiative (CHDI) to provide HIV treatment and comprehensive primary care by training community health workers, establishing hospitals and health centers, and providing equipment, food, and medicine.