LILONGWE, 4 Jan 2006 (IRIN) - QUESTION: What is your general impression of the health system in Malawi?

ANSWER: The health system in Malawi is in a very dynamic process of improvement right now. But I know there are a number of challenges: these ... include shortage of staff, and there is need to recruit more to meet these challenges; the other challenge facing the health system is the supply and management of drugs.

As you know, Malawi, with the assistance of the donors, is implementing the Sector-Wide Approach Programme (SWAP), in which resources are pooled from donors in order to help recruit and maintain health workers in addition to funding existing programmes. Government's decentralisation programme will help quite a lot, in that the healthcare services will also have to be decentralised. With the donor assistance, this programme will improve the harmonisation of the health system.

Q: In the past years we have seen hospitals running out of drugs, with patients going back home without getting any treatment. What do you think is the problem?

A: I think sometimes it is the problem of capacity and systems that have been put in place. It is true that in Malawi, just like in many other countries, procurement and distribution system of drugs need to be improved. It is quite often ... problems of understaffing and sometimes the system is not functioning properly.

But also sometimes there is a problem of infrastructure, where you do not have enough space to store the drugs, and here in Malawi there is work that is going on to improve the work of the Central Medical Stores. Government is working with its partners to sort out the problems.

In addition to that, there is also need to improve drugs management at district level. They should be able to quantify their stock needs so that delivery works well. WHO, for example, has provided support to people working at district level in this regard. What I am aware of is that there is a shortage of staff and we need people who are qualified, such as technicians and nurses, so that they are able to procure and manage the drugs properly.

Q: The government is losing a lot of qualified doctors and nurses to other countries because of low pay and poor salaries. Do you think this problem can be sorted out?

A: What government should do, together with its partners, is to improve the working conditions of staff and improve on their salaries. Currently there is dialogue going on, facilitated by WHO, to try and compensate poor countries that lose their health workers to other countries. This is an issue which has been debated at WHO assemblies - the discussions are still going on - and the aim is to persuade rich countries to fund poor countries so that more doctors and nurses are trained.

Q: Do you think Malawi is doing enough in the fight against HIV/AIDS?

A: I think Malawi has done extremely well in scaling down the transmission of HIV. When you compare what was happening three years ago, you will see that the number of people dying of AIDS has now been reduced. People were in a state of despair because they had no drugs that could prolong their lives.

Malawi has again expanded its policy from testing and counselling to prevention, and the country is fighting other diseases such as TB - it happens that in most cases people with TB are also infected with HIV. The Malawi government has done well in providing care and resources to AIDS and TB patients. The establishment of the National AIDS Commission (NAC) is the most effective way of dealing with HIV/AIDS and it is working well in Malawi. The area that government now needs to work on hard is the area of prevention of HIV. The other area that needs to be ... [tackled] is prevention of the transmission of HIV from mother to child.

Q: Do you think Malawi will achieve the UN's Millennium Development Goals related to health by 2015?

A: With what is happening currently, Malawi is likely to reach it. There is a lot of commitment from government, donors and all its development partners. The National AIDS Commission is doing tremendous work in the fight against AIDS and Malawi is one of the best examples in the region. HIV infections are now being stabilised and this is attributed to a number of factors, some of which I have already mentioned.