For the past couple of months, I have been in the Republic of Malawi carrying out my International Public Service Project (IPSP) as part of the curriculum at the Clinton School of Public Service, where I’m currently earning my Masters Degree. My placement was with The William J. Clinton Foundation, more specifically with the Clinton Hunter Development Initiative (CHDI) in the Republic of Malawi. Malawi is a democratic, densely populated country located in the southeastern region of Africa. The national language is Chichewa, although those who are fortunate enough to attend school learn and speak English. Malawi gained its independence from the UK on July 6, 1964. Malawi has a GDP per capita of 596 US dollars, which makes it one of the five poorest countries in the world. Its three most important export crops are tobacco, coffee, tea, and sugar.
For the people fortunate enough to earn a living in Malawi, most are earning between $0.30 and $0.70 cents per day. Subsistence farming is the way of life—people try to grow enough food on their property to feed their families. The life expectancy in Malawi is around thirty-six years old, and the number has been steadily dropping over time due to the country's impoverishment, which is constituted by the following factors: lack of foresight by the government, lack of access to medical care, insufficient nutrition, insufficient school education, low income (less than $1 a day), rapid spread of HIV/AIDS, government economic restrictions, and corruption. Out of every ten children born in Malawi, one does not survive birth. The primary health issues in Malawi are HIV/AIDS (infection rate of 14.2%), Malaria, and water-borne illnesses.
The Clinton Hunter Development Initiative (CHDI) was announced as one of the first commitments at the inaugural meeting of the Clinton Global Initiative in September 2005. The Clinton Foundation and the Hunter Foundation (based in Scotland) established CHDI with seed funding of $100 million to be used over 10 years, to develop a self-sustaining, integrated and systemic approach to poverty alleviation. CHDI’s holistic approach integrates four core elements: agriculture (food security), health, clean water and sanitation, and education.
At the Malawian government’s request, CHDI is initially focusing on three districts in Malawi: Chitipa, Dowa, and Neno. My main focus for the summer was working on health and health infrastructure issues in the Neno district, primarily with CHDI’s partnering organization, Partners in Health. CHDI is responsible for the implementation of health-related programs in Malawi, including existing Clinton Foundation HIV/AIDS Initiative (CHAI) efforts and overall efforts to strengthen the Malawian healthcare system. As part of this effort, Partners in Health (PIH) began working in Malawi with CHDI in the beginning of 2007.
Neno district currently has no hospital. The current health facility is about 2,500 square feet and sees more than two hundred patients everyday, with a staff of three, the most senior of which is the equivalent of a second year medical student in the United States (until the PIH physicians arrived in February 2007). CHDI is working with PIH to expand the district health center to create a district hospital, staffed by PIH physicians and local clinicians, which will have five times as many hospital beds and offer significantly more life-saving health services. The clinic will provide primary care, including care and treatment for HIV, TB, and malaria. CHDI is also funding and managing the construction of twenty-three district hospital staff houses that will be used as incentives to attract good physicians and clinicians to Neno to work in the new district hospital. The Clinton Foundation and Partners in Health are working together with the Malawian Government to build a sixty bed hospital that will employ 150 people, including thirty nurses and fifteen highly educated medical doctors. As many as 100,000 people in the Neno district (and beyond) will have access to free healthcare and free prescription drugs, including ARVs (anti-retroviral) and other first and second-line drugs that fight HIV and AIDS. In order to make sure that the new hospital is staffed by well-trained, government-certified health workers, CHDI and PIH are also building up the capacity of local, trained health workers.
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