Malawi's Fight Against Tuberculosis Undermined by Debt, Donor Reliance
With TB still among the top 10 causes of death worldwide, experts fear that without urgent action, the preventable and treatable disease will continue ravaging vulnerable populations.
LILONGWE, Malawi— Malawi's efforts to tackle the infectious disease tuberculosis are being severely undermined by heavy reliance on international donors and crushing national debt that is hampering health investments, experts have warned, writes Emma Ngwata.
Speaking at a media forum in the capital Lilongwe recently, researcher Dr. Benjamin Azaria Mosiwa said Malawi depends far too much on foreign aid to implement its TB program amid ongoing economic struggles leaving the national budget stretched thin.
"Through the first assessment that we conducted we looked on one of key factors that would affect implementation of TB program in Malawi, and we found out that economic situation is a big challenge that hinder the implementation of TB program in the country, because we keep having economic mishaps which there is over reliance to implement TB program in the country," Mosiwa told journalists.
Mosiwa pointed to a recent TB political economy analysis conducted by the TB LIGHT consortium in Malawi, which found that over reliance on donors and weak investments in the health sector are significantly weakening the national response on TB.
With tuberculosis killing more people worldwide than HIV/AIDS and malaria combined, experts worry that Malawi's overdependence on outside funding coupled with limited domestic health resources could severely impede efforts to tackle the debilitating disease, which thrives amid poverty and poor living conditions.
Although he commended partners for contributing resources, Mosiwa noted that lack of updated disease surveys and high inflation are also reducing the purchasing power of available funds to fight TB in Malawi, where spending on health per capita is the lowest in the Africa region.
Meanwhile, Dr. Samuel Chirwa of Malawi's National TB Program struck a more optimistic tone, saying that the number of reported TB cases has been consistently declining each year since 2015, keeping the country on track to meet global targets for reducing deaths and infection rates by 2030.
But Chirwa agreed on the urgent need for "national updated survey data" to provide a more accurate picture of the true TB disease burden and guide targeted interventions going forward.
"The last TB prevalence survey that we conducted in 2014 we found that older people over the age 55 and urban residents are a lot of TB and with that, then we deployed more active case findings in those areas," he told attendees.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria has set ambitious targets to raise $18 billion in coming years to save 20 million lives globally, and reduce mortality from HIV/AIDS, TB, and malaria by 64 percent.
However, even though TB kills around 1.5 million people annually — more than HIV and malaria combined — experts note that only 18 percent of the Global Fund's overall spending is allocated to TB.
According to the fund's new strategy, while 50 percent of the first $12 billion in spending between 2023-2026 will go to HIV, just 18 percent will be invested in TB efforts.
A larger 25 percent share will be dedicated to TB as cumulative funding tops $12 billion in that period, but advocates worry that is still insufficient given the massive death toll.
Rhoda Mbeta, a TB survivor who is now an advocate, made an impassioned plea at the science cafe event for ending stigma and discrimination, saying that "any person can get TB."
She explained that TB patients can live healthy, normal and productive lives with proper treatment, yet many are ostracized.
"TB patients, can live healthy, normal and productive lives, yet many are stigmatized and discriminated against," Mbeta stressed.
Veteran Malawian journalist George Ntonya emphasized that the lack of adequate financing and investment for TB control and treatment is lowering public awareness in the country.
Limited funding translates to reduced media coverage and messaging around the disease, Ntonya said.
He also noted that many Malawian TB patients grapple with hefty out-of-pocket payments at health facilities, as well as transportation costs to travel long distances to access clinics.
Corruption and misuse of public resources are a significant component of the socioeconomic fabric of Malawi and have been cited as a key development challenge the country faces.
In the health sector, misuse of public resources manifests itself in leakages of medicines and commodities, especially at health facility levels.
Informal payments demanded at public health facilities also remain a problem, he added.
With TB still among the top 10 causes of death worldwide, experts fear that without urgent action, the preventable and treatable disease will continue ravaging vulnerable populations in countries like Malawi.