Just like many countries in the world Malawi has been affected by COVID-19 and the cases are rising every day. As of June 8th, 2020, there were 443 cases with confirmed COVID-19, with 55 who have recovered and four deaths [1].

Located in sub-Saharan Africa, Malawi is a landlocked nation bordering Tanzania to the north, Mozambique to the east and south, and Zambia to the west. The country has an area of 118, 500 sq km, of which one-fifth is water, largely Lake Malawi [2]. The UN estimates that by the end of June 2020 the population of Malawi will be 19,129,952 [3]. The vast majority of Malawians live in rural areas (85%) [3]. The country is divided into 29 health districts located in three geographical regions; Northern, Central and Southern.

To protect the lives of its vulnerable citizens during disasters and reducing their exposure, the Government of Malawi, led the development of a National Coronavirus Disease (COVID-19) Preparedness and Response Plan [4]. On 20th March, the Malawi leader declared Malawi a State of Disaster on the basis of the Coronavirus attack. Strict measures to prevent the spread of COVID-19 were introduced, including limiting gatherings of more than 100 people in churches, funerals, weddings, political rallies etc. Another important policy decision made was directing the Ministry of Health to recruit 2,000 health workers to assist in the fight against the pandemic.

On 14th April, the Malawi government announced that the country would be in lockdown. Citizens were given four days to prepare for the lockdown which was set to be implemented for 21 days. However, this received serious resistance and condemnation from the opposition parties and non-governmental organisations. One non-governmental organisation obtained an injunction from the courts on 17th April preventing the government from implementing the lockdown measures. Since then the country has not been locked down.

Automatic water and soap dispensing machine at the Malawi University of Science and Technology (MUST). Picture: MUST Website

Malawi is currently facing a constitutional crisis. On 19th May 2019, presidential, parliamentary, and local government elections were held. The race was tight, but the incumbent head of state retained power. The opposition went to court to dispute the results and on 3rd February 2020, the constitutional court nullified the elections and ordered that fresh elections be held within 150 days after the court ruling. The supreme court of appeal also upheld the lower court decision on 8th May, following an appeal from the incumbent head of state and the Malawi Electoral Commission.  This means that Malawi needs to have fresh elections sometime before 2nd July 2020. This has proven very challenging in terms of following COVID-19 measures such as physical distancing. We have seen all political parties, both ruling and opposition, conducting rallies, engaging supporters to vote for them. This is a very interesting scenario because the courts stopped government from going into lockdown and the same courts want the government to hold an election amidst COVID-19. Now, the situation is encouraging everybody to campaign; undermining social/physical distancing. This is risking lives of innocent Malawians, especially those who cannot access quality health services.

The principal secretary from the Ministry of Health and vice chancellor of MUST demonstrate hand washing techniques. Picture: MUST website.

Amidst all these challenges, the country is making some positive steps in fighting COVID-19. For example, the Malawi University of Science and Technology (MUST) designed and developed an automatic water and soap dispenser that would help reduce risk of contamination as people touch taps and soap bottles during hand washing. This innovation is mobile and can run on three sources of power: electricity, solar and batteries. This means it can be used in both urban and rural settings. Bearing in mind that Malawi population lives in rural areas, this is an important innovation. Moreover, the country experiences frequent power cuts and load shedding due to high demand for electricity.

The system is bulky because inside it there are three buckets: 1) a water bucket, 2) soap bucket and 3) another bucket to collect the used water. The system can also be adapted (making it small) to cater for those who have running water, who can connect it directly to household or office water system. For used water, it can be connected to an outlet directly linked to the drainage system.

To show his appreciation for this innovation, on 1st June, the head of state visited MUST and engaged academics and students who are developing other innovations in response to COVID-19.

Staff at MUST are also designing and producing ventilators, face shields, reusable face masks, hand sanitizers, disinfection chambers and other COVID-19 related products and devices. MUST has also led the design of a tracking system to prevent, minimize and contain the spread of corona virus. Other universities in Malawi are working on various initiatives to fight the virus, including oxygen breathing machines to support patients with respiratory problems, drones for collecting samples and providing laboratory support and research leadership in fighting COVID-19.

However on his return from University of Science and Technology (MUST), the same day, the president conducted two whistle stop rallies and addressed his supporters who gathered in large numbers, without observing physical distancing.

The head of state and first lady of Malawi visit Malawi University of Science and Technology (MUST) students. Picture: MUST Website

Other important initiatives that have been made in Malawi are that the country now has 13 laboratory facilities conducting COVID-19 tests. This is positive progress, demonstrating that we now have facilities conducting tests in each region. Another important policy decision was leadership of the government response in relation to the establishment of a special committee on COVID-19 on 8th March. This committee was comprised of eight cabinet ministers, chaired by the Minister of Health who lacks training and experience in health. This received a lot of critism, with speculation that the public could doubt if the cases being reported were really true. In response, the head of state dissolved the original committee and established a Presidential Task Force on COVID-19. This is co-chaired by a cabinet minister and a medical doctor and academician who is a specialist in public health. This Task Force is inclusive, comprising leadership from the opposition, community members, advocacy organisations, and religious leaders, among others.

In conclusion, the COVID-19 situation in Malawi is complicated by national politics. Whilst the opposition are demanding that the election should be held, telling their supporters that the biggest COVID-19-related threat is the current government, the government is introducing measures to prevent the spread of COVID-19 but facing strong resistance. At the moment the number of cases is rising, risking a crisis in a health system which is already fragile.

  1. Worldometer. Malawi: Coronavirus Cases Total Coronavirus Cases in Malawi 2020 [cited 2020 08/06/2020].
  2. Central Intelligence Agency. The World Factbook Central Intelligence https://www.cia.gov/library/publications/the-world-factbook/geos/mi.html, 2020.
  3. Worldometer. Population of Malawi. https://www.worldometers.info/world-population/malawi-population/ 2020 [cited 2020 05/06/2020].
  4. Ministry of Health. NATIONAL COVID-19 PREPAREDNESS AND RESPONSE PLAN. The Republic of Malawi Ministry of Disaster Management Affairs and Public Events 2020 [cited 2020.

Dr Kennedy Nkhoma is postdoctoral Research Associate in Global Health at King's College London, Cicely Saunders Institute. Currently working on ASSET WP5 (Integrating palliative care in primary care). His research interests are designing, testing and evaluating complex interventions, Systematic reviews, randomised controlled trials, Quantitative and qualitative methods, long term conditions such as HIV/AIDS, cancer, COPD, heart failure, pain and symptom self-management.