Poor ill-served by health care

Poor rural Malawians, especially women, have less access to healthcare in Malawi than any other group, IRIN has learnt. Access to health is a universal human right, yet in Malawi access to healthcare is largely influenced by whether the person in need of care is male or female, urban or rural and rich or poor. Mindful of this problem, Malawi's ministry of health recently hosted a meeting on "gender and equity in health". Health and Population Minister, Yusuf Mwawa said Malawi's poor account for 65 percent of the population, 30 percent of whom live in extreme poverty. "Poverty and illness are two (factors) ... that feed on each other in a lethal cycle. Poverty leads to illness through poor nutrition, poor and over-crowded housing and vulnerability in relationships," he said. As a result, illness exacerbated poverty due to the cost of seeking care, the loss of income and reduced productivity, Mwawa said. Nothing underlines this more than a case, documented by Malawi's TB Equity Project, of a woman identified only as Doreen, from the Ntcheu district, in central Malawi. Doreen was diagnosed with tuberculosis (TB) but, because her family could not afford transport, was never taken to hospital. Doreen's condition deteriorated, she coughed continuously, sometimes vomiting and grew so thin and weak that she could not leave the house. Yet still she was not taken to hospital, where TB treatment is free. When a visiting health worker asked the family why Doreen was not admitted for treatment, her father said: "When we reach the hospital she dies and they say 'you go back with the dead body', I do not have money." Doreen subsequently died. This shocking story is but one of many recorded in 2001 by the TB Equity Project, as part of the National TB Programme. It highlights the difficulties poor Malawians, especially women, have in accessing healthcare. Even when treatment is free, the cost of the drugs means it is still out of reach for thousands of people like Doreen. Malawi's health indicators are among the worst in the world. During the last five years life expectancy at birth has dropped from 43 years to 39 years. In 2000, the infant mortality rate was estimated to be 104 per 1,000 live births and the maternal mortality rate was 1,120 deaths per 100,000 live births. One of the highest maternal mortality rates in the world. It is estimated that 53 percent of the 10 million population do not have access to safe water. While 56 percent of all pregnant women attending antenatal clinics are anaemic. Evidence suggests that ill health is concentrated among the poorest and had a differential impact on women and men, Mwawa said. For example, the mortality rate of children under 5-years-old is higher in rural parts of the country, where poverty is more prevalent, than in the urban areas, where poverty levels are less. This is significant because 80 percent of Malawi's population live in rural areas. "Promoting equity in health and healthcare delivery is already a central principle of the Malawi health policy. The Malawi Poverty Reduction Strategy (MPRS) is currently being drafted and aims to achieve sustainable poverty reduction through empowerment of the poor," Mwawa said. "We need to gather information on the links between poverty and health, so that we can assess the impact of improved health outcomes on poverty reduction. We need to learn from practical initiatives which help to reduce the illnesses, and the service gaps, to the poor," the minister said.