On strengthening primary care

De Maeseneer, et al's1 editorial reflect our experiences delivering health care in the rural areas of Malawi's central region.

Our NGO's initial work was in AIDS orphan support and AIDS education; in every village we found a significant number of children needing medical attention for acute and chronic conditions. Investigation found they had no practical access to medical care, because of poverty and geographical location. Typically the tarmac road would be over 25 km away and the nearest health facility a further 40 km. If the sick child made the journey, the choice would be between a government hospital where treatment, although free, is limited from chronic shortages of clinical staff and pharmaceuticals, or the mission sector where treatment is paid for, often beyond the means of the poor.

Our response was to set up a children's mobile clinic, taking primary health care to the villages. Utilising 4 × 4 vehicles stocked with a wide range of medicines, our team of clinical officers and nurses treat over 30 000 sick children annually.

On our busiest day in 2007, our two Malawi clinical officers and a volunteer doctor from the UK dealt with 407 patients presenting with a full range of tropical diseases seen in Central Africa, including those targeted but as yet not reached by the listed Global Fund vertical programmes. The fact that the children's parents/guardians will travel for up to 2 days to be seen by our team indicates their lack of alternatives. Vertical programmes will never reach these children.

We have expanded our programme to include a mobile operating theatre for minor surgery in the field, vaccines to support the national immunisation programme, antiretroviral drugs (ARVs) for PLWA children (children under 13 years of age with AIDS were initially excluded from the Malawian ARV roll out) and in partnership with UNICEF, an initiative in the prevention of mother to child transmission of HIV through prophylactic ARVs and exclusive breastfeeding for the first 6 months of infancy.

A key part of our work is integrating care with other healthcare providers, making cost-effective primary health achievable. Those diagnosed with conditions requiring specialised treatments have their transfers facilitated without the need for other levels of bureaucracy.

Our experiences persuade us that this form of primary health care is the most effective use of donor money.

• © British Journal of General Practice, 2008.