Although national health services in Malawi are theoretically free of charge at the point of delivery, they are mostly unreliable and grossly inadequate. For those living in rural areas, the nearest health centre can be up to ten kilometres away along rough dirt roads, staffed by minimally trained health surveillance assistants and often lacking in even the most basic drugs and medical supplies. Long journeys are particularly hazardous at night in the large swathes of the country with no electricity. Patients attending these centres after dark, including women in labour, are routinely expected to provide their own candles or kerosene lamps for use when they arrive. Latest estimates suggest that there is approximately one doctor for every 50.000 people (Malawi News). This results in the district hospitals being mainly staffed by clinical officers, medical assistants and nurses. As wards in the four central hospitals are similarly understaffed, overcrowded and insufficiently equipped, many of the more serious or complex medical conditions simply cannot be diagnosed or treated and palliative care is extremely limited (Medicine in Malawi).
The potentially fatal combination of food poverty and nutrient deficiencies weakens the immune systems of the poorest families and has resulted in widespread malnutrition. The staple food in Malawi is nsima, a thick dough made from maize flour and boiling water. It is cheap and filling, but it has little nutritional value. Save the Children estimates that one child in eight dies before their fifth birthday in Malawi. Half of all children under the age of five have stunted development. Health passports are issued to all children at birth and are used to record their medical history and growth chart. The majority of child deaths are due to preventable diseases. For example malaria is one of the top three causes of death of children under 5 years of age (Science Against the Spread of Malaria). Around a million Malawians are thought to be HIV positive and AIDS is the leading cause of death in adults, leaving many parents unable to work and over 500,000 orphans living with their grandparents or struggling to support themselves in particularly vulnerable child-headed households (Unicef Data Survival HIV and AIDS).