Vulnerability, access to health services and impact: a gender lens on TB, HIV and malaria in Malawi

This paper synthesises the different research findings in Malawi to explore how gender roles and relations affect the way in which key diseases related to poverty are experienced at the community level. We highlight background information on Malawi with an overview of the three diseases: HIV/AIDS, tuberculosis and malaria” and of the methods used and provide a conceptual framework on how gender shapes (1) vulnerability to TB, HIV/AIDS and malaria, (2) access and adherence to services and (3) the impact of being ill on individuals and households

The Malawi National Tuberculosis Programme: an Equity analysis

Background: Until 2005, the Malawi National Tuberculosis Control Programme (NTP) has been implemented as a vertical programme. However, in the first half of 2005 the NTP reoriented its planning, approach and budgeting in line with the Sector Wide Approach (SWAp). Monitoring of equity performance of the programme requires synthesis of baseline information on TB programming, access and development of strategies to promote equity. Methods: A consultation was undertaken with key stakeholders on critical equity issues in tuberculosis (TB). The results are situated within a synthesis of reports and studies on equity and access to services. An additional analysis of routine data enabled a national overview of access to TB services by socio-economic status to be created. Results: TB cases have increased rapidly. This increase has been attributed to HIV/AIDS. Although there is no TB prevalence data, the WHO estimates that only 48 percent of TB cases are detected in Malawi. Equity analysis of routine data highlights a lower utilisation of TB services by populations with limited access to health facilities. The complexity of TB diagnosis requires repeated visits, long queues, and delays in sending results. This reduces the Poor\'s ability to access and adhere to services. The costs of seeking TB care are high for poor women and men - up to 240 percent of monthly income as compared to 126 percent of monthly income for the non-poor. Conclusion: The NTP has attempted to be responsive to the needs of different social groups, for example through the development of interventions in prisons, decentralisation of treatment and piloting of community based activities to improve equitable access to services. The Programme of Work which is being delivered through the SWAp is a good opportunity to enhance equity and pro-poor health services. The major challenge is to increase case detection, especially amongst the poor, where we assume there are many ‘missing cases\'. In addition, the Programme needs a prevalence survey which will promote service access amongst ‘missing\' women, men, boys and girls. Malawi Medical Journal Vol. 18 (1) 2006: pp. 13-1

Developing research partnerships to bring change: experiences from REACH Trust, Malawi

Drawing on the experiences of REACH Trust, this paper highlights practical lessons of using research processes and outcomes to promote equity in health policy and practice. The REACH Trust is first introduced. Case studies are then used to highlight how REACH Trust has worked in a participatory manner with key stakeholders at community, national and international levels. In addition to participatory working there are a number of cross-cutting themes that facilitate the uptake of research findings which is discussed in turn: (1) multi-disciplinary and multi-method approaches (2) advocating research findings at strategic forums, and (3) the use of strategic frames. In the conclusion it is argued that research has a critical role to play in responding to the urgent need for the Malawian health sector to develop and act on evidence-based practice in a more gender equitable and pro-poor manner. Malawi Medical Journal Vol. 18 (2) 2006: pp. 50-5

Developing research partnerships to bring change: experiences from REACH Trust, Malawi

Drawing on the experiences of REACH Trust, this paper highlights practical lessons of using research processes and outcomes to promote equity in health policy and practice. The REACH Trust is first introduced. Case studies are then used to highlight how REACH Trust has worked in a participatory manner with key stakeholders at community, national and international levels. In addition to participatory working there are a number of cross-cutting themes that facilitate the uptake of research findings which is discussed in turn: (1) multi-disciplinary and multi-method approaches (2) advocating research findings at strategic forums, and (3) the use of strategic frames. In the conclusion it is argued that research has a critical role to play in responding to the urgent need for the Malawian health sector to develop and act on evidence-based practice in a more gender equitable and pro-poor manner