Major Communicable Diseases
Apart from malaria, the other major communicable diseases are tuberculosis, HIV/AIDS and STIs.
With regard to tuberculosis, the effort to collaborate and support the HIV/AIDS programme is paying off. More cases of tuberculosis are being ascertained and treatment failure is diminishing. The tuberculosis MDG targets provide a measure of success (Figure 1).
Figure 1 Tuberculosis MDG Indicators
The treatment success rate at 86% is slightly above the World Health Organization (WHO) target of 85%. However, the case detection rate (46%) is still below WHO target (70%). Through the National Tuberculosis Control Programme additional strategies have been developed to include the private sector and also increase the detection rate while maintaining the treatment success rate.
Sexually Transmitted Infections including HIV and AIDS
This component of the EHP consumes the greatest resources with direct costs in the order of an estimated 16% of the direct costs for the first year of the programme. This is, however, expected to increase as the country moves towards universal coverage for new ART regime. As part of the HIV prevention strategy, the health sector provides 25 million and 1 million of male and female condoms, respectively, per annum. HIV testing and counselling is an integral part of the HIV prevention strategy. Approximately 1.8 million people were counselled and tested for HIV in 2009/2010, which is 28% of the sexually active population. HIV testing among couples is limited and in the HSSP there are strategies to promote couple testing because of the high level of HIV discordant couples (Figure 2). Another key prevention component is Prevention of Mother to Child Transmission (PMTCT). In 2009/10 37% of HIV positive mothers received appropriate drugs and counselling. The HSSP provides strategies for increasing this annually by 10% over the five year period. Testing and treatment of other STIs is an important HIV prevention activity.
About half the number of cases as estimated in the BoD study were treated in 2010. The strategic plan has put in place strategies to increase this number by improving access by 10% a year.
Figure 2 HIV cases 2007
Figure 3 ARV coverage by Zone
ARVs are the mainstay of treatment. The criteria of who benefits from ARVs change as and when advice from WHO is updated. So far the implications are that more people will benefit from them. In 2009/2010 with the criteria for starting ARVs based on a CD4 count of less than 250 cells per mm3 , 228,468 adults were on ARVs which was 71% of eligible cases and 22,519 children were on ARVs, which was 29% of eligible children (Figure 13). Strategies have been put in place to increase adult coverage to 80% in 2011/2 and by 20% each year in children to reach the MDG target of 80%. Numbers will have to be revised upwards in the course of the implementation of the HSSP if additional resources are mobilized to fund the additional cases derived from the CD4 count change to 350 and maternity cases.
Figure 4 Adult and child ART coverage in Malawi
Alongside ARVs is the treatment of Opportunistic Infections (OIs) and community-based home care for AIDS patients. Currently, the coverage of OI treatment is about 20% of need and there are plans to increase coverage by 10% annually. The coverage of home-based care is about right but the quality of care and the availability of drugs are important and need improvement.