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Financing the Search for the Missing Millions: Q&A with Malawi Hepatitis Focal Point

By Christa Bugg, Task Force Communications Intern

Viral hepatitis is a silent killer. In 2019, nearly 80% of people living with viral hepatitis were unaware of their infection. Dubbed the “missing millions,” these people may go untreated for decades, which could lead to suffering from severe liver disease, liver transplantation, and even death. Countries with limited resources and insufficient testing capacity are grappling with how to diagnose and treat persons living with hepatitis.

During Hepatitis Awareness Month in the U.S., Dr. John W. Ward, the Director of The Task Force’s Coalition for Global Hepatitis Elimination (CGHE)  is moderating a panel, “An SDG Target We Can Reach: Financing Viral Hepatitis Elimination,” during the World Economic Forum in Davos, Switzerland on May 25, 2022. 

“Now is the time for action to avert 4.5 million deaths from hepatitis,” said Ward. “Innovations simplifying care, lessons learned from pioneer programs in countries such as Egypt, and health system transformations coming from the pandemic response make hepatitis elimination more achievable than ever.”

One example of how CGHE helps countries develop strong hepatitis elimination initiatives is in Malawi, where CGHE, the Malawi Ministry of Health, and Partners in Health Malawi collaborate to  improve testing policies and implementation strategies for effective and economical national hepatitis elimination efforts.

This partnership is part of CGHE’s Hepatitis Evaluations to Amplify Testing and Treatment (HEAT) project which provides countries catalytic funding and technical assistance for baseline epidemiological assessments, laboratory capacity evaluations, and epidemiological modeling to inform development of improved viral hepatitis testing and treatment policies.

We spoke with the Chief Medical Officer for Malawi’s Department of HIV and AIDS Dr. Ethel Rambiki who serves as the national hepatitis focal point and liaison between the Ministry of Health and HEAT partners. 

What does the HEAT project mean for Malawi’s hepatitis elimination efforts?

Since 2019, nothing much has moved from our end because the hepatitis program here in Malawi doesn’t have a lot of resources. It is entirely dependent on government funding which has been  a very small amount, about 23 million Kwacha, approximately $1.4 million. Once you divide that up across the various implementation activities, it becomes even smaller for each of the things we need to do to work toward hepatitis elimination such as creating policies or making disease testing more accessible to people which requires a lot of time and resources. So when colleagues from  Partners in Health notified me about the HEAT project, I quickly jumped on it because I knew it would help us move forward on many hepatitis elimination activities. Now that we’ve joined the project, within a few weeks I can already say that the project has been a lifesaver. At this moment, I am at a review workshop for the national viral hepatitis strategic action plan, so we’re already making great progress.

What are the main activities you hope to achieve through the HEAT project?

By early 2023, we are aiming to address four key activities:

  1. Publish a national action plan for the elimination of viral hepatitis with appropriate targets and a monitoring and evaluation framework;
  2. Finalize locally adapted clinical guidelines for hepatitis B virus (HBV) and hepatitis C virus (HCV) and training of healthcare workers;
  3. Synthesize available data on  HBV and HCV burden of disease based on literature review and review of hospital records, blood bank information systems, and cancer registries;
  4. Assess the laboratory capacity for scaling up HBV and HCV testing nationally

Once the HEAT project is complete, what will be next for the hepatitis program Malawi?

In the future we are looking at a more coordinated response in the viral hepatitis program. Because of activities like the  Malawi blood transfusion units and cancer registries, we feel that the engagement of stakeholders is going to give us a more coordinated response in terms of data management and data tracking. At the moment we don’t have enough data on the burden of viral hepatitis on the health of Malawians and accessing testing is very difficult. However, once we have the national action plan and the clinical guidelines and the other learnings from the HEAT project then we will be able to work with the districts who are the implementers and conduct activities such as training healthcare workers and public awareness campaigns to encourage the public to get tested and learn about viral hepatitis. Additionally, data will help us allocate our resources more efficiently in the future. For example, understanding which age groups are the most at risk of hepatitis infection will help us allocate resources to activities that address the most at-risk groups. So, I think this project is a stepping stone for future investments and future planning.


Coalition for Global Hepatitis Elimination


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