What is Malawi’s way forward? What are we going to decide as a nation?
These are the questions that when answered I’ve come to call “invisible wins.”
As a Global Health Corps Fellow at Malawi’s Ministry of Health, I participate in meetings where these questions are posed to Ministry staff and development partners ranging from UN agencies to local non-profits. In global health, we’re often inundated with images of tangible, glamorous victories—a shiny new health facility, a successful delivery of drugs and supplies, a mother cradling her healthy, albeit preterm newborn. At the ministry, we operate at 30,000 feet –a bird’s eye view of these wins. Ideas are fleshed out and decisions are made behind conference room doors, a space less conducive to photo ops. It’s not always obvious what factors beyond funding and manpower lead to the implementation of projects, or standards and protocol on the ground.
Malawi is on track to achieve United Nations Millennium Development Goal #4, reducing under 5 child mortality. There is no doubt that national policy interventions, coupled with other efforts in this sphere contributed to this success. But even with this notable achievement, Malawi’s high neonatal death rate is a setback to achieving this goal. The Ministry of Health is currently assessing how to move forward with a nationwide scale-up of steroids used for premature newborn survival. Weeks after we facilitated orientation sessions with district health officers in every region, a research study questioning the drug’s effectiveness caused the ministry and its partners to halt training and other activities. While specialists around the world are ruminating and debating over the study’s findings, Ministry staff have been meeting and asking tough questions, such as “what do we do as a nation when babies are still dying?” The more often the Ministry staff can convene, review information and evaluate the nation’s best options, the sooner an agreement and action plan for implementing partners can be reached. This translates to faster responses for NGOs, medical stores, hospitals and health care workers so they can proceed in an effectual and standardized manner. And when it comes to life-saving interventions, time is of the essence.
As global health embraces technological innovations and private sector partnerships, government processes are increasingly viewed as decelerating and archaic. Nevertheless, the ministry is where national policy is established on best practices and baseline standards directly affecting construction and drug commodities. Furthermore, they assess where the nation stands in quality and capacity of care by constantly evaluating their goals and targets. The next time you see photos of NGO workers tracing and monitoring diseases such as Ebola, pause to think about the Ministry of Health guidelines that help steer these efforts.
With technical guidance from partners like the World Health Organization and input at the stakeholder level, reaching consensus on how to move forward as a country can be an arduous process. Assessments are undertaken, data evaluated and analyzed and voices with conflicting priorities may be at play. And when agreement on how to move forward is reached, it can take years to realize on the ground. But it’s the progressive, yet invisible win towards success.