constraints to implementing the essential health package in malawi马拉维的约束来实现基本卫生包.pdf

Constraints to Implementing the Essential Health Package in Malawi 1 2 1 1 Dirk H. Mueller *, Douglas Lungu , Arnab Acharya , Natasha Palmer 1 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom, 2 Daeyang Luke Hospital, Lilongwe, Malawi Abstract Increasingly seen as a useful tool of health policy, Essential or Minimal Health Packages direct resources to interventions that aim to address the local burden of disease and be cost-effective. Less attention has been paid to the delivery mechanisms for such interventions. This study aimed to assess the degree to which the Essential Health Package (EHP) in Malawi was available to its population and what health system constraints impeded its full implementation. The first phase of this study comprised a survey of all facilities in three districts including interviews with all managers and clinical staff. In the second and third phase, results were discussed with District Health Management Teams and national level stakeholders, respectively, including representatives of the Ministry of Health, Central Medical Stores, donors and NGOs. The EHP in Malawi is focussing on the local burden of disease; however, key constraints to its successful implementation included a widespread shortage of staff due to vacancies but also caused by frequent trainings and meetings (only 48% of expected man days of clinical staff were available; training and meetings represented 57% of all absences in health centres). Despite the training, the percentage of health workers aware of vital diagnostic and therapeutic approaches to EHP conditions was weak. Another major constraint was shortages of vital drugs at all lev