Malawi Site Visit Short Report

College of Medicine, University of Malawi

SAMSS Site Visit Short Report

Site Visitors:

From the Advisory Committee: Prof. Josefo João Ferro and Dr. Dela Dovlo.

Advisory Committee Host: Prof. Mwapatsa Mipando.

From the Secretariat: Prof. Seble Frehywot and Prof. Tenagne Haile-Mariam.

From the left: Prof. Frehywot, Prof. Ferro, Dr. Dovlo,
Prof. Haile-Mariam, and Prof Mipando.

Malawi is a small Southern African nation of about 13 million people. The top four causes of death in Malawi are all infectious diseases. The top cause of death is HIV/AIDS, which infects an estimated 14% of the population—twice the overall rate in Sub-Saharan Africa. Malawi has a severe shortage of healthcare workers, with less than 300 physicians in the country to care for these severe needs. The College of Medicine at the University of Malawi is the only medical school currently training doctors inside the country to begin to address its enormous burden of disease.  Professor Mipando guided the SAMSS team through a visit that explored the College of Medicine’s vision, curriculum, and facilities.

 
The Anatomy Department was the first department built in 1991 at the
founding of the College of Medicine.

The College of Medicine (COM), a constituent college of the University of Malawi in Blantyre, started to train doctors in 1991. In 1986 a tripartite commission (from the UK, West Germany and Malawi) mapped the future of the COM. The commission recommended a medical school based in community medicine and public health which would reflect the needs of Malawi. The COM enshrined this philosophy in its mission statement: “To be an academic centre of excellence, responsive to the health needs of Malawi and its neighbors within the Southern African region in training of professionals, provision of clinical services and medical research.” Indeed, the COM has become exemplary in its work to gear its approach toward addressing the primary medical needs in Malawi. 

While on their rotations in the community, medical students live for
short periods of time in houses like this one to increase their
understanding of the lives of the people whom they serve.

The COM’s Community Health Department has become a cornerstone of the college. Medical students work extensively in the community starting from the first year of their education. This gives the students firsthand exposure to the health needs in their area and the impact a doctor can make, which is reported to be one of the main reasons many of the COM’s doctors choose to remain in Malawi rather emigrating in search of better salaries. The COM’s curriculum centers on the ten most significant causes of death and disability in Malawi so that the doctors who graduate will be prepared to practice in their local context.

Facilities such as this lecture hall (left) and this classroom (right) at the
College of Medicine, both comfortably equipped for medical instruction, 
are built and furnished largely through the COM’s innovative
funding mechanisms.

The community focus in the COM’s curriculum has been woven into an “integrated curriculum”, meaning that students take a systems-based approach to learning. Students will learn anatomy, physiology, pharmacology, and medicine related to the cardiovascular system all at once, then move on to the next system. At the end of their medical education, students are required to complete an 18-month internship. At the end of the internship, all students are able perform cesarean sections and minor surgery. Additionally, the internship includes a three-month course in health management, since many Malawian physicians become managers at various levels of the health system.

Three medical students work at one of the COM’s well-equipped research
laboratories.

Malawi has established an innovative an unique Research Support Center. The COM’s leadership decided that it was important for the college to have a robust research capacity. This would lead towards solving the nation’s fundamental health problems, build capacity and problem-solving skills in the students and faculty who conduct the research, and encourage faculty retention by providing an opportunity for faculty career development. In order to foster a supportive research environment, the COM developed the Research Support Center. The Center provides services common to many research projects, including assistance writing grants, managing project budgets, designing clinical trials, and performing statistical analyses. The Center takes a 10% indirect fee from each grant, which supports the Center’s activities and provides general educational budgetary support to the College.

The new library under construction at the College of Medicine is one of
the many infrastructure development projects readily visible around
the campus.

Because of constraints within Malawi’s national budget, the COM has developed a broad financial base to help ensure budgetary stability. The COM’s administration requires each department to come up with an Income Generating Activity (IGA). The IGAs should find a way that each department’s capabilities match with a local need. For instance, the Anatomy Department has established a contractual relationship with the Blantyre city morgue that brings in a nominal fee for autopsies performed. These IGAs seem to be an innovation that could strengthen many other medical schools in the region. 

The Sports Complex (pictured) uses its top floor as a club for paid public
members which serves as its Income Generating Activity (IGA).

In addition to the COM’s departments’ income generating activities, the University has formed relationships with many outside donors. The COM has been able to leverage support from the Global Fund to fight AIDS, Tuberculosis, and Malaria (GFATM), the Norwegian Agency for Development Cooperation (NORAD), and the Swedish International Development Cooperation Agency (SIDA), among others. The COM has also built effective regional partnerships; its faculty development programs in cooperation with the Southern African Development Community (SADC) have built faculty capacity and encouraged faculty retention. The effective use of governmental support, research funds, IGAs, and partnerships has allowed the COM to undertake a number of infrastructure development projects, which portend the COM’s growing role in Malawi’s health system.

A medical student walks outside a set of newly constructed dormitories at
the College of Medicine.

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