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Too Little Testing in Malawi and Covid-19’s Poverty Face

There is a queue outside of the Covid-19 testing site standing astutely close to the morgue at Kamuzu Central Hospital in Lilongwe. It is usually not long, with usually no more than 10 people at a time. The staff inside are occupied with a full day’s work for any reasonable workload 2 staffers can take. One will observe the couple of chairs reserved for clients that are hardly sanitized before the next set of clients walk in.

But this article is not about the sanitary habits of this testing site, nor any testing sites across the country. We wanted to shine a light on the sobering low numbers registered in Covid-19 testing across the country, which is as much a result of public hesitance as it is structural. Perhaps there are times hesitance can easily result from the structural problem we identify.

To date, i.e., Sunday, 19 September 2021, and according to the Ministry of Health, Malawi has conducted 401,808 tests across the country since the pandemic hit the country, resulting in the corresponding 61,363 Malawians (citizens and residents) who have been certified as positive cases. The curious question this article wants answered is, then, what would the data tell us if we, say, doubled the amount of testing? Would we have at least double the number of incidence of Covid-19 patients? How would our landscape look today if we awoke to such a reality, and what sort of measures would we put in place to further mitigate the likely more expansive spread of the SARS-COV-2, the virus responsible for Covid-19?

All answers point to testing and how we are approaching the exercise. Let’s start with individual Malawians, who are hesitant to get tested. Negative publicity that has flooded social media and religious connotations around Covid-19, persuasive enough to lure many into non-conformity, has and continues to play an important role in the low turnout at testing sites. The nasal poking of the swab freaks out many folks too. But the similarity of key Covid-19 symptoms with malaria – a disease we have become too accustomed to in Malawi – can also be a major factor in patients' discernment of which of the two illnesses is at play at any given time. In Lilongwe, when one patient with malaria-like symptoms visited the African Bible College Clinic early August 2021, a doctor ordered a malaria test and a full blood count to check for bacterial infections. Not Covid-19! The patient tested positive a day later when a PCR Covid-19 test was conducted on them at Partners in Hope.

Besides our social failings, however, our system for testing has two key deficiencies. The first concerns the private provisioning of testing on the market. It costs at least MK15,000 and a minimum of MK20,000 to have a rapid and PCR test conducted, respectively. In a country with a minimum monthly pay of MK35,000 for a large part of the population that relies on public spaces to make a living - in turn, being the most at risk of contracting the coronavirus, the pricing model for Covid-19 tests automatically discriminates the rich from, at the very minimum, the working poor.

The second structural challenge is more disturbing. While testing in this case is provided by the government – for free – the established process creates constraints for Malawians who inevitably rely on free public healthcare. According to the Ministry of Health, one must obtain a referral from their local health centre to a district hospital, where they must obtain a referral to access the testing site at Kamuzu Central Hospital. The young man and woman tending to patients at KCH’s testing site, well programmed to this fact, send patients away whenever patients fail to meet this condition. Now, the reality in Malawi is that it is likely to take more than a day or two to go through these referrals successfully for a KCH test to be conducted. It also happens to be an imposition of transport costs and exposure of the general public to potential positive cases for especially the poor that public healthcare is designed to cater to the most. The unintended effect is that the rich, who may have the right connections in the system and access to efficient transport, are the ones that eventually benefit from the free services provided at our referral testing sites.

A worrisome consequence of the stringent testing is the likelihood of so many Malawians, who could potentially behave more responsibly if they knew their Covid-19 status, roaming around public spaces and transmitting it further. As such, this website believes that the reported figures on Covid-19 cases in Malawi could be several times higher if more testing were done.

More testing is the likely impact of extensive testing on national policy for fighting Covid-19, including to prevent the spread of new mutations that could potentially challenge current preventive means and vaccines. So, at a time when a pandemic is set to determine the choice between life and death for some, access to a basic service such as testing should be a universal public offering. All health centres should be equipped with both rapid and PCR testing kits, even when the analysis needs to be done at more centralized locations. Even then, laboratories must be installed in all District Hospitals so results can be obtained relatively quickly. The current system, where even an exorbitant testing service as one at Partners in Hope (MK20,000), requires at least 2 working days to release test results as tests kits must be sent to an already-overloaded CHSU in Area 3 for analysis).

A mobile phone SMS system can convey test results much faster to patients.

We're headed towards a trough in the Covid-19 incidence curve (yesterday, Malawi registered only 26 cases), with fewer and fewer cases being recorded. But this week's article shares an experience that could comprise lessons for now or the impending future when a resurgence is likely to recur.



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