University of Limerick and Gorey-Malawi Health Partnership

Background

The Gorey Malawi Health Partnership links the Palms GP Surgery in Gorey, Ireland with St John's Hospital in Mzuzu, Malawi. The University of Limerick is the Irish academic partner led by Prof Liam Glynn. It focuses on the management of noncommunicable diseases such as hypertension, diabetes, asthma, and heart disease. In response to the COVID-19 pandemic it developed and disseminated education materials using social media in a collaboration involving the Irish College of General Practitioners, HSE and ESTHER Ireland. www.esther.ie/covid-19

The quality of our work was acknowledged in 2018 by ESTHER Ireland when we achieved accredited partnership status www.esther.ie. 

Our Approach 

We work with health workers and institutions to strengthen health systems particularly in the area of noncommunicable diseases (NCDs). We assist with the gathering and audit of data to examine present practice and drive change using online databases. We work with stakeholders to develop locally appropriate clinical protocols, align pharmacy stock policies and educate clinical and management staff in areas such as clinical guidelines, quality improvement and leadership skills. Education uses e-learning, peer-to-peer education and remote mentoring using webconferencing. The University of Limerick in Ireland and Mzuzu University in Malawi allow the partnership to benefit from the strengths, capacities and networks of the wider University and stakeholders in developing the partnership.  

Our Principles 

• Everything we do is to benefit those in need of primary healthcare 
• Work through partnership 
• Focus on long-term sustainability 
• Developing best solutions through research and evaluation 

Why NCDs? 

A recent WHO Report highlights “of all the major health threats to emerge over the past 10 years, none has challenged the very foundations of public health so profoundly as the rise of chronic non-communicable diseases (NCDs)”. Heart disease, cancer, diabetes, and chronic respiratory diseases - once considered a problem only of affluent societies - are now global concerns, with the heaviest burden concentrated in low- and middle-income countries (LMICs). Furthermore, the impact of these conditions will be greatest on individuals living in the poorest countries. NCDs have now overtaken infectious diseases as the leading cause of death worldwide accounting for 70% of all deaths worldwide. In a low or middle income country the probability of dying of a chronic disease between the ages of 30 and 70 years is up to four times higher than in wealthy countries. 

Why Malawi? 

It is one of the poorest countries in the world, ranked 153 of 169 countries. 51% of the population live on or below $1 per day. Despite this there is mobile phone coverage is 99.6% of the population (World Bank). This provides the opportunity to provide education and clinical support using mobile technology Attempts to control NCDs in Malawi are failing at present. In a recent WHO survey one third of the participants had high blood pressure but 95% of people with high blood pressure were not on medication. 

Our own work has shown that community based health workers remain unequipped to manage the existing burden of NCDs under their care. For example, 26% indicated they would do nothing for a suspected diabetes patient believing there were no facilities to manage the condition in Malawi. 65% had no access to a blood pressure measuring device. 

More recently our work has focused on rheumatic heart disease. This condition is all but forgotten in high income countries but remains a major cause of morbidity and mortality in low income countries such as Malawi. Dr Tedros WHO Director General has described it as a "disease of inequity". This condition affects 3% of schoolchildren in Malawi. 

List of current projects 

• Asthma quality improvement initiative 
• COMPASS - COllaborative Medicine, Pharmacy And Systems Services for sustainable changes in management of hypertension 
• Development of an e-learning platform for NCDs 
• Rheumatic heart disease management 
• BIOTOPE - Biomarkers to Diagnose Pneumonia. Introduction of pneumococcal vaccine to reduce bacterial pneumonia in primary care in Malawi. 
• Covid-19 series of 14 educational videos series via WhatsApp or Facebook for health institutions, healthcare workers and patients. Prepared in collaboration with the Irish College of General Practitioners, the Health Service Executive Global Health Programme, Esther Ireland and Standing Voice. These were also utilised in the Public Health education programme of the Malawi Ministry of Health. 
• A short presentation outlining the approach can be viewed here