Transitional Experience (From GF Initiative to Government Run Institution) of a Wellness Site: The Case of the Mwanza Border Wellness Site between Malawi and Mozambique Abbreviations

1. AIDS ………………………………….Acquired Immune Deficiency Syndrome.

2. GF……………………………………….Global Fund.3. DC ……………………………………. District Commissioner.4. DHO ………………………………….District Health Office.5. DHMT……………………………….. District Health Management Team.6. HIV …………………………………….Human Immune Deficiency Virus.7. HSA…………………………………… Health Surveillance Assistance. 8. MOU ………………………………… Memorandum of Understanding.9. MSF-B……………………………….. Medicines San Frontier Braceros. 10. MRA …………………………………..Malawi Revenue Authority.11. NSA …………………………………. North Star Alliance.12. NSO …………………………………. National Statistic Office.13. STI ……………………………………..Sexual Transmitted Disease.14. SADC …………………………………Southern Africa Developing

Community.15. T.B ……………………………………..Tuber Closis.

1.0 Background InformationMwanza District is located in the southern region of Malawi. It is bordered with Neno to the North-East, Chikhwawa to the South, and Republic of Mozambique to the North-West. The District has two Traditional Authorities (T/A), one Sub T/A and 123 villages. It has a population of 104,556 (NSO 2015).

Mwanza District Hospital was officially opened on 12th May, 1981 with a bed capacity of 250, however bed occupation is now around 350 on average. There are 3 reporting health facilities which are all owned by Ministry of Health Malawi. (HMIS 2016).

The District has four private clinics of which one is owned by BLM and one Wellness Centre serving as an outreach clinic at the boarder of Malawi and Mozambique (HMIS 2016). There are two private pharmacies in the district. The district receives referrals from Chikhwawa district (Gaga, Chithumba and Chang’ambika Health Centers), due to geographical barrier, Neno district (District Hospital is not fully functional) and Mozambique (Zobue and Mkondezi Health Centers).

Mwanza Wellness Centre was opened in 2005 by World Food Organization as a distribution food centre during the Mozambique war.

2.0 Objective of the Project

It was handed over to the government as a Wellness centre with support from North Star Alliance to serve the mobile population ( truck drivers, sex workers and the surrounding population) on HIV and AIDS, STI and T.B and other diseases.

3.0 Outcome of the project1. The mobile populations were served accordingly on sexual transmitted

diseases.2. The government owned the site as an outreach and took responsibility

in collaboration with the NSA.3. When NSA had no funding to pay for the workers, the government

( Mwanza DHMT) took the responsibility to run the site and also

identified other partners to work with. This is one of the best Practices in the sense that other Partners such as NGOs and the Private Sector are part of the transition.

4. The government also added other services like provision of free ARVs to truck drivers who would have forgotten or lost their drugs on transit , malaria testing and treatment, OPD services among others.

Now the site is providing other services including injuries of the mobile population and Mwanza district also has started cross boarder initiative with Mortise district in Mozambique to assist in disasters, outbreaks and any other health related problems across the border from 2012 up to now. Another innovative example of how borders on different countries could work together. So far this is the only example of such close border initiatives developed at the local level, without even a memorandum of understanding between the two national governments. Decentralization in Malawi has allowed local authorities to make such bold moves. One other innovative approach is the regular meetings between Health and Border Officials from both countries to discuss common issues affecting the two borders.4.0 Collaborating partners1. MSF-B (Doctors without borders) who started in 2014 also have an office

in Tete Province in Mozambique. They help in payment of the staff at the border, pay electricity and water bills, Supervision of the site, provision of drugs when the District Health Office (DHO) has not managed to procure.

2. North Star Alliance also assists in provision of some data equipment, maintenance of the containers among other things.

3. Malawi Revenue Authority provided free space for the containers since 2005, provision to the DHO on the security guard for the site and also supervision with the DHO and collaboration on boarder activities with the DHO to prevent outbreaks of diseases.

The District Health Office is responsible for supportive supervision, provision of medical and drug supplies, waste disposal, ensuring quality standards as per Malawi regulation, mentorship of the staff, lobbying of partners and resources, Ensuring Nation supervision and accreditation by HIV/AIDS unit on the services offered, reporting to the District Commissioner during the

District Executive Committee meetings on the progress of the site as part of sustainability and ownership.

Picture below shows Mwanza Wellness Site before New Container

Picture below shows officials from members states visiting Mwanza Site

Mwanza Wellness Centre New Site in preparation for the new container

Picture below show Mwanza Wellness center with new container as of 1st

Mach 2017

4.1 Preparation for Official Opening of Mwanza Wellness Site

1. Mwanza DHO with his partner MSF-B will install an electric billboard and colored posters around that will help truck drivers, sex workers to know where the site is at Mwanza boarder by March 2017.

2. The old container will be painted with the same color as that of the new container.

3. Electricity and all the electric appliances have been fitted and the facility in in operation.

4. There will be a steel fence with a new shelter in front of the container for the clients and will be fitted by March 2017.

5. Mwanza DHO is sending clinicians as part of government initiative to support the site as a means of sustainability.

6. The DHO Mwanza Malawi Revenue Authority has procured 15 waste bins and distributed around the border area, and also all the

stakeholders and surrounding community have been vaccinated with cholera vaccine to prevent cholera outbreak with support from UNICEF and Malawi Red cross.

7. The partner as conducted a sensitization meeting with the local leaders and stakeholders from the border area and the partner will also conduct sensitization meetings to Transport Association Committee from the Southern Region of Malawi by April 2017.

8. The official opening of the site will be done in April 2017 where all the stakeholders in the district, Ministry of Health Officials, Media and SADC Secretariat will be invited to witness the occasion.

9. Meanwhile the Mwanza DHMT is lobbing from more stakeholders to support the site and mean while Save the Children, URC with support from European Union has shown interest to join. First meeting will be conducted on 7th March 2017.

The picture below shows Joint meeting of Officials from Mwanza (Malawi) and Mortise (Mozambique) on cross boarder health collaboration.

Picture below shows Joint Stakeholder Meeting with DHMT during the Health review meeting improvement including the Wellness Centre

5.0 Innovative approaches at Mwanza District MalawiMwanza District Health Office provides drugs to the wellness centre including truck drivers and sex workers who have forgotten their ARVs for free. Apart from HIV, STI, TB activities the site does malaria test and soon we shall start wound dressing for the drivers and any other help holistically.The Mwanza DHMT does supportive supervision of the site.The site is like an outreach clinic where, if staffs from the site are not available for whatever reason the District Health Management Team (DHMT) sends its own staff to work. There is no specific security guard paid for by the Wellness site but with collaboration with other government departments District Health Officer uses Mwanza Malawi Revenue Authority guards.The wellness centre is also monitored by the District Executive Committee and every quarter the DHO gives a report to the committee on the progress that’s why the Malawi Revenue Authority gave the land to put new containers for free.The Non-Governmental Organizations who work in health activities supports the DHO but do not dictate on how to run the wellness centre.Mwanza wellness Centre also has materials for waste disposal, Personal Protective Wears Kits for Ebola all provided by the DHO.Waste disposal and management is done by the DHO.Malawi has developed a steering committee for wellness centers.The district has got a coordinator on the wellness centre who reports to the DHO but all the DHMT members are oriented and are involved in the activities of the wellness site.Mwanza DHO also conducts cross boarder initiative with Mortise in Mozambique every quarter to discuss issues on disaster, patients’ referral, and disease outbreaks. The next steps of these joint meetings will be looking the referral letter in English and Portuguese and also discuss on the way forward on the MOU between the two districts. This would be the first direct MOU between borders that is not through the national government which is also another Mwanza site innovation. At least all the NGOs who work with the District Health Office has signed an MOU on how they will support government to avoid misusing the resources.

6.0 Conclusion

Mwanza Wellness Centre is the only site in SADC that has been handed over since government is able to run the health services to the mobile population with little support from the partners. The decentralization system in Malawi, has helped Mwanza district make its own decisions on how its health services can be managed including the Wellness centre. The District Health Management Team with the District Health Officer as a leader and the District Commissioner as the head of all government departments, is well oriented on the services at the border and they own the services. The SADC Secretariat acts as an advisor whenever it is consulted.

Reported by:

Raphael Lawrence Piringu

Mwanza DHO, Malawi.