Population burdens health sector

In Malawi, Christmas is not just the birthday of Jesus Christ who Christians worship as the Son of God.

For the Ministry of Health, it is the day to release the number of Christmas babies graciously.

Strangely, authorities keep mum on the count of healthcare facilities built for the new citizens to thrive.

The counts include 1628 Christmas babies born in 2022, about 1400 in 2021 and 589 in 2023.

The population pressure is felt in underfunded public facilities such as Queen Elizabeth Central Hospital (QECH) in Blantyre where patients sleep on cold floors in congested wards.

The hospital named after the longest-serving queen of Britain opened its doors with 400 beds in 1957 when the country was home to 3.38 million people.

A fierce scramble for limited beds, drugs and health workers plays out in the ancient red-brick hospital as the country’s population has hit 21 million.

After 67 years, QECH has 1 350 beds for 3.4 million people in its catchment area.

QECH controller of administrative services Sipho Nyasulu says the hospital has been overtaken by a rapid population boom.

He says: “We don’t have space to accommodate all patients admitted. Some are forced to sleep in the corridors and others between beds.

“The situation is the same for doctors and other health workers. The doctor-patient ratio is very high.”

The sick are seen sleeping on cold floors, waiting for the few on beds to die or get discharged.

“For three days, my patient has been receiving treatment from the corridors as we are waiting for a vacant bed,” said a desperate guardian.

Nearly 1 503 health workers at the overwhelmed hospital see every 500 outpatients daily.

The World Health Organisation prescribes three doctors for about 10 000 people, but the shortfall is massive nationwide.

According to the Ministry of Health, the country’s hospitals lack half of the skilled staff required to manage common conditions effectively.

The high vacancy rate persists even though healthcare spending consumes 12 percent of the national budget, up from 8.8 percent in the 2023/24 financial year.

Parliament has more than doubled the healthcare budget from K330 billion to K723 billion during the period. However, it means the government is only willing to spend K34 428 to meet the health of every citizen.

This leaves the rapidly growing population at the mercy of donors who contribute over 80 percent of healthcare funding.

There are similar lamentations in the education sector.

Chichiri Primary School in Blantyre has seen enrolment spiked from 490 to 1500 learners since the 1960s.

A teacher at Blantyre’s oldest school serves 81 learners against the Ministry of Education’s recommended ratio of one teacher to 60 learners. In some classes, a teacher sees 120 learners who scramble for few resources.

A teacher said the school receives four textbooks for a class of 200 students, meaning 50 shares each book. Standard One to Four learners sit on dusty floors due to lack of desks.

Meanwhile, government says it cannot recruit trained teachers for its underserved population, which requires more schools, classrooms and essential teaching and learning resources.

An average Malawian woman is likely to have four children in a lifetime, according to the 2018 census.

This is higher than other countries’ fertility rates, but it hits seven children in rural households and drops to one or two in urban settings.

Mercy Kalua, a mother of six in Chilomoni Township in Blantyre, says: “It is never easy for a parent and government to raise more children than one can adequately support.

“This worsens poverty, but low access to sexual and reproductive health services, including family planning methods and information, is to blame.”

Social commentator Lucky Mbewe says Malawi needs to invest more in youth empowerment programmes to reap the dividends of the growing youthful population.

“The growing youthful population could be the new gold to lift this country out of poverty, but we need to invest in the right sectors, including quality education, relevant skills and reliable healthcare services,” he said.

Mbewe admires India and China, which utilise their bulging billions as their trusted workforce and markets, but he is worried that Malawi’s youthful population remains unskilled and dependent.

To community health activist Maziko Matemba, the babies born each day confirm that the fertility rate remains high, with a third of girls giving birth before their 19th birthday.

“The government should continue investing in the girls’ education to delay the age when girls become mothers. Girls should be in school,” he said.

The 2013 Addis Ababa Declaration on Population and Development in Africa requires governments and their partners to invest in transforming the tricky population dynamics and unleashing the youth’s full potential to boost the country’s socio-economic development.

According to the declaration, countries can reap the population dividend with sustained investments and improvements in education, skills development, public health, economic growth, job creation and good governance.

However, Malawi’s population is growing faster than investment in the prosperous future for all.

The National Statistical Office projects the population to leap from 17.6 million in 2018 to 33.6 million in 2050, but the UN warns that it could reach 43.2 million.