General introduction
Malawi is one of the countries with the lowest physician to patient ratio worldwide. This is particularly true for the child and adolescents population (up to 18 years) which accounts for 51% of the total population. Currently, the estimated ratio of Paediatricians to child patients in Malawi is 1:50,000. Less than 40 Paediatricians serve in the health system. The severe shortage or absence of doctors, particularly those who are specialized in paediatrics and child health, greatly affects access to, provision and quality of primary care for children in Malawi. This leads to a significant burden in morbidity and mortality among the children.
‘Paediatricans for Malawi’ is a three-year (2021-2024) partnership project between the Kamuzu University of Health Sciences in Blantyre, the global child health group at the Witten/Herdecke University in Germany, and the Medical Association Westphalia-Lippe, funded by the Else Kröner-Fresenius Stiftung. Its goal is to enhance/improve child health by providing opportunities for Malawian registrars to hone their expertise in Malawi and overseas to become specialized paediatricians. Simultaneously, German registrars deliver services at a local tertiary care hospital, supporting their colleagues in providing clinical care. The project underlines mutual learning and sharing experience between Malawian and German paediatric trainees and serves as a blueprint for other similar projects.
What
This project aims to achieve the following goals:
- To support the training of Malawian registrars in Malawi and South Africa to become paediatric specialists
- To support child health services in Malawi by increasing the paediatric workforce and by seconding German registrars to Malawi
- To enable German registrars to undergo part of their specialist training in Malawi
Why
Malawi´s surging population growth inevitably leads to increasing demands for child health care. However, the number of paediatricians in Malawi is critically limited. Access to post-graduate training is also not widely available – Kamuzu University of Health Sciences is the only medical school that confers Masters in Medicine (MMED), but lack of financial security often becomes a barrier for individuals to pursue such training. Meanwhile, medical professionals in Germany also face challenges due to changing patterns of patients’ demographics and diseases with the tide of globalisation. Examples include an increasing proportion of patients with foreign backgrounds and the emergence of unfamiliar infectious and non-infectious diseases that are rarely reported nationally. The locally accumulated hands-on experience of German doctors in Malawi has the potential to reciprocally contribute to the health services in Germany.
How
Seven Malawian doctors undergo approximately three years of postgraduate training at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Their training covers general paediatrics, infectious diseases (e.g., HIV, TB), basic neonatology, cardiology, emergency medicine, and malnutrition. Subsequently, they receive further training for 15 months at a large paediatric centre in South Africa, focusing on areas that are not covered in Malawi, such as renal medicine, advanced neonatal care, and endocrinology. In parallel, six German paediatric trainees and 12 volunteers serve at the same hospital for six months each. The training they undertake, including delivering clinical services, conducting teaching sessions, and completing clinical audits in Malawi, will be accredited by the regional medical council in Westphalia Lippe, Germany, and will eventually count towards their specialization.
Achievements
1. Seven graduates from KUHeS in Malawi were selected
2. Six German candidates were identified, and an additional six positions were offered to volunteers
3. Malawian registrars commenced training in general paediatrics at QECH in 2021 and completed the first MMED exam
4. To date, six German registrars and five volunteers have benefited and completed six months of training and service delivery