Implementing Innovative Approaches to Healthcare in a Lower-Middle Income Country: Perspectives from Malawi.

Emma Larsson,Hastings Gondwe,Mala Mawkin,Griphin Baxter Chirambo,Peter Harrington,John O'Donoghue,Simon D Taylor-Robinson,Mark Ledwidge,Joseph Gallagher,Chris Watson

doi:10.2147/ijgm.s285130

Abstract

IntroductionSafe, reliable, and effective healthcare systems are essential for all nations to ensure the health and wellbeing of their citizens. However, this is not always achievable with clinical therapies constantly evolving, resulting in a domino effect of structural, policy and training changes. For low- and middle-income countries (LMICs), implementing change is restricted. It is essential that innovative and realistic solutions are developed, so that effective change can be realised in LMICs.Materials and MethodsIn this report of a global health conference held in July 2019, six perspectives are presented which aim to generate long-term positive change in Malaŵi. Perspective 1: Pneumonia – the BIOTOPE study (BIOmarkers TO diagnose PnEumonia) sought to determine the aetiology of pneumonia in children presenting in primary care. It assessed blood-based markers of bacterial infection as part of a rapid diagnostic approach to better utilise existing resources in Malaŵi. Perspective 2: Cardiovascular – the CARDIA project (CARdiac Dysfunction in Africa) was established to assess clinical and biochemical phenotypes of diabetic patients in Malaŵi. Perspective 3: Asthma – an observational study was conducted to implement a health system strengthening initiative for asthma. The use of locally adapted formularies and protocols with ongoing online mentoring through expert partnerships provided an opportunity to sustainably build capacity. Perspective 4: Sustainable Partnerships – establishing the Malaŵi electronic Health (eHealth) Research Centre, an international hub to develop education, research and innovation for long-term collaboration. Perspective 5: Part-Time PhD Studies – undertaking a part-time PhD within a LMIC provides logistic challenges, but also a number of opportunities for observational research. Perspective 6: Medical electives – an undergraduate elective allows real exposure to global health and facilitates life-long collaborations at an early stage in a medical career.ConclusionMalaŵi is an under-doctored and resource-poor country. North-South partnerships in Malaŵi should be strengthened with particular emphasis on healthcare innovations, such as eHealth, which allow healthcare problems to be highlighted early while preventative measures are still possible.

Highlights

Safe, reliable, and effective healthcare systems are essential for all nations to ensure the health and wellbeing of their citizens
It is currently estimated that 415 million people worldwide suffer from diabetes with more than 80% living in low- and middle-income countries (LMICs)
Cardiovascular disease is on the rise as it is estimated that the number of people with hypertension in Africa will increase by 68% from 75 million in 2008 to 126 million in 2025

Summary

Introduction

Democratic republic in South-Central Africa. Formerly known as Nyasaland, it gained independence from the British in 1964 and was subject to years of a one-party state under the first President of the country, Dr Hastings Banda. Mzuzu University academic staff members are critical to the long-term devel opment of eHealth across Malaŵi through Education (skills development), Research (identification and devel opment of new technologies/processes) and Innovation (implementation of new approaches to enhance healthcare delivery) This has helped to reduce the potential for high staff turnover as highlighted by Bates et al[22] as one of the key challenges in North-South partnership building. Two final year medical students (MM and EL) travelled to Malaŵi as part of the Malaŵi eHealth Research Centre exchange programme (www.ehealthmalawi.org), visiting a variety of hospitals, clinics, mission workers, embassies and the Ministry of Health to see first-hand how data and innovation were driving change in Malaŵi’s healthcare system They were faced with a wide range of realities which healthcare systems within a LMICs face on a daily basis.

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Disclosure