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The Documentary Podcast
Malawi: Life in your years
00:35:36
What does increased life expectancy mean in one of the poorest countries in the world?
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- [00:00]
Dr. Andrew Jamali
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- [00:33]
Lea Malekano
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- [01:11]
Dr. Andrew Jamali
If you take a country like Malawi, one of the poorest countries in the world. In 2000, life expectancy in Malawi was 46 by 2019. So 19 years later, life expectancy was 65. So that's a 19 year increase in 19 years.
- [01:32]
Ruth Evans
Peter Sands is the Executive Director of the Global fund to fight HIV, TB and malaria.
- [01:38]
Lea Malekano
Two thirds of that 19 year increase.
- [01:41]
Dr. Andrew Jamali
In life expectancy were due to the reductions in mortality of hiv, TB and malaria.
- [01:50]
Lea Malekano
This is an astonishing achievement that should be celebrated.
- [01:54]
Ruth Evans
But on the flip side, what does this very rapid demographic change mean for governments, policy planners and above all, ordinary people now living so much longer?
- [02:04]
Lea Malekano
I am Lea Malekano, a Malawian journalist.
- [02:07]
Ruth Evans
And I'm Ruth Evans and together in this BBC World Service documentary, Life in youn Years, we'll be exploring the accuracy.
- [02:14]
Lea Malekano
Of these statistics and asking what it means for countries like Malawi. These are my twin boys, Michael and Micah, born six months ago.
- [02:28]
Deborah
Mommy, how are you?
- [02:29]
Lea Malekano
I'm fine baby. And this is my daughter and she's just four years. Like any new parent, I wonder what sort of life they will have ahead of them. So many things have changed in the country. The population is growing so fast and maybe me also have just added to the. At the same time as people are living longer. According to WHO, Malawi's population will increase nearly 80% to 37 million by 2050, as opposed to 21 million today.
- [03:10]
Ruth Evans
Life expectancy at birth is one of the most frequently used health status indicators.
- [03:15]
Lea Malekano
But what exactly do we mean by life expectancy?
- [03:18]
Sarah Harper
I'm Sarah Harper, I'm the Professor of Gerontology at the University of Oxford and I direct the Oxford Institute of Population Ageing. Life expectancy from birth is how long one would expect to live if the, what we call the mortality characteristics of, of the present pertained across your life. And the other way of thinking of it is if you like the average that one can expect a population to reach. And of course at one level that doesn't really make sense because from the day that you are born, particularly in a modern society, you're likely to live much, much longer because healthcare and scientific advances are going to increase. Alternatively, in a poorer society, it's very difficult to take into shocks like climate change or in lower and middle income countries. When we look at advances in life expectancy, what we're really doing is pushing mortality or death back across the life course, which means that we're tackling infant mortality, child mortality, maternal mortality, and so nearly all the gains are at the younger ages.
- [04:29]
Ruth Evans
Gains in life expectancy of birth can come about due to several factors, including rising living standards, improved lifestyle or treatments and better education, as well as greater access to quality health services, as happened with HIV patients in Malawi.
- [04:44]
Lea Malekano
The HIV AIDS epidemic peaked in Malawi in the 1990s. Since then, treatment has reduced HIV transmission, enabling people to live with HIV without developing or dying from aids.
- [04:57]
Dr. Andrew Jamali
We've seen that there's a drop in HIV AIDS prevalence rate now. We are in single digits, somewhere around 8% now of the total adult population. So that signifies that we've made really greater strides comparing to the 22,000 and tens where we were almost like 14% HIV population.
- [05:13]
Ruth Evans
Dr. Andrew Jamali, research manager at the government's National Planning Commission, tasked with gathering the information needed to make plans for Malawi's future.
- [05:22]
Dr. Andrew Jamali
That kind of improvement in terms of HIV conditions that really helped to improve our life expectancy. And also government has invested quite a lot in terms of education and that has attributed to improved living conditions because I mean, educated people are able to get some good jobs, they are able to take care of their health. So that has also helped to increase a proportion of people that are likely to live a bit longer.
- [05:43]
Ruth Evans
The rate of increase of life expectancy, it's been very short period of time, almost 20 years. In 20 years, that's much faster than anything Europe saw when its life expectancy was increasing with industrialization. It's also higher than much of the rest of Africa, which I believe is about 10%. How do you explain that? Malawi seems to be doing so much better than neighbouring countries in Africa on this front. What is the reason for that?
- [06:08]
Dr. Andrew Jamali
But I think one of which has been sustained donor support to the health sector added with the increasing proportions that government has been adding to the health sector that could account for those kind of changes, training and capacity building across the health sector, that has also been good enough. I mean recently I've seen a graduation of almost 1,000 health surveillance assistants in the country. I mean that tells you that's a big investment. Government has really enhanced the outreach services in the communities and that has really helped to address most of the health problems. So that kind of sustained investment in the health sector has really been attracting, attributable to the changes that you can actually talk about in terms of our life expectancy, in terms of the reducing burden of disease and perhaps maybe HIV AIDS infections, that has been tremendous.
- [06:54]
Ruth Evans
But at the same time you've got a rising burden of non communicable diseases. Alzheimer's, dementia, stroke, high blood pressure, those sorts of things as people live longer.
- [07:04]
Dr. Andrew Jamali
Yeah, that's, I mean like from the nutrition sector we would call what we call maybe a double burden of disease because I mean you have malnutrition and obesity. Obesity is rising, particularly in the urban areas. The demands for health education, food security and nutrition services. Investment in social services is quite immense.
- [07:22]
Ruth Evans
There are currently around a million older people in Malawi who make up around five and a half percent of the total population. But their number has nearly doubled since 1987, highlighting the growing importance of addressing their needs and challenges. Traditionally, in societies like Malawi, older people were looked after by their extended family. They had a lot of children as insurance against old age. But as more young people moved to the cities hoping for a better life. Is that still the case here in Malawi do you think, Leah?
- [07:55]
Lea Malekano
Yeah, things have not changed, but you see issues of neglecting elderly persons, especially in the rural areas where you see children abandoning or neglecting their parents because they are older. We have come now to Salima, about 100 km east of Lilongwe, close to Lake Malawi. 94 year old Gogo Sambadi was born here in 1930. Kogo Sambadi lives in a house which doesn't have iron sheet roof. It's just plastic and grass on the roof without even windows. She had 10 children, eight passed away and now she has only two. Six died due to road accidents, but two died because of HIV and now she's living with a great grandchildren. So the husband died in 1962, long time ago. Yes. So the Time the husband was dying, she was working as a nurse. So she had to raise all the children by herself. But she stopped working in 1968.
- [09:39]
Ruth Evans
Do you have a pension from your career as a nurse?
- [09:46]
Lea Malekano
She hasn't been receiving the pension money. She's saying that she doesn't receive any assistance from government. They give money to the elderly and people that are very, very poor. There are some in this village who are receiving that assistance, but she's not. So she just sleeps sometimes without eating.
- [10:13]
Ruth Evans
Sitting next to Gogo Sambati on a plastic tarpaulin on the bare mud floor is Charity, the great granddaughter who now looks after the 94 year old.
- [10:27]
Lea Malekano
They grow their own maize, but they don't have money to buy feturizer. Most of the times the food that they eat, they buy. She's saying life is really very hard here in the village, especially when it comes to finding food every day. The prices of things are changing. Sometimes they go without eating anything, but they still work hard to feed their family, including the grandma.
- [11:03]
Ruth Evans
Despite life's hardships, Gogo seems remarkably content with her lot in life.
- [11:10]
Lea Malekano
She's saying that she's just grateful to God that she's living a healthy life like this. She was saying that it is very difficult now to go to the hospital at her age because there is no nearby health center. So they have to walk long distances to go to the hospital. And some people die on their way. That's the very big challenge in this community.
- [11:45]
Ruth Evans
Kamuzu Central Hospital is the main referral hospital in the capital Lilongwe, with about 60 doctors and 300 nurses, serving over 5 million people in central and northern Malawi.
- [11:59]
Lea Malekano
My name is Grenadio. I'm the senior nursing officer at Kamu Central Hospital. It's one of the biggest referral hospital. We offer free services here at Kamu Central Hospital that has also contributed to the increase of the life expectancy.
- [12:20]
Ruth Evans
We've just walked up four flights of stairs because the lifts don't work or you get stuck, stuck in them when the power goes off. So conditions are quite challenging for people to work in. The lino on the floor is cracked and peeling away. Some of the beds are very old looking.
- [12:34]
Lea Malekano
The resources here, like the buildings, have been mostly the same and the population is still growing.
- [12:41]
Ruth Evans
There are supposed to be 780 beds, but the hospital is always full to bursting, says Greener.
- [12:47]
Lea Malekano
Outside in the corridor you find other patients also lying on the floor due to the overwhelming pressure. And as you can see, the elder is here. We don't have a GERIATRIC ward, but we have female ward and male ward, so it's just a mixture from 15 years to even 100 plus years.
- [13:10]
Ruth Evans
There are a lot of older people here.
- [13:12]
Lea Malekano
Yes, a lot of older people with conditions, diabetes, hypertension.
- [13:18]
Ruth Evans
And do you have medical staff that specialise in geriatric care?
- [13:21]
Lea Malekano
I don't know anyone who has specialized in geriatric care. It's just general medical care.
- [13:27]
Ruth Evans
Do you think Malawi is prepared for this increased life expectancy? It's very good on one hand, but it presents new challenges. Do you think as a health professional that you are prepared to face this challenge?
- [13:40]
Lea Malekano
To be honest, we are not prepared. We are trying really, but with very limited resources. Such a challenge, you know, it's a developing country. Everyone is struggling in this country economically.
- [13:55]
Gerald Mantalu
The longer people live, we are happy. People have a longer period to contribute to society.
- [14:02]
Lea Malekano
Dr. Samson Mdolo, Principal Secretary at the.
- [14:05]
Gerald Mantalu
Ministry of Health however, very soon we'll be having a large pool of people, old, retired, not working. The system will have to find a way of sustaining them again. When you think of diseases that are common in old age, non communicable diseases, hypertension, diabetes, etc. Yes, the health care system will be strained.
- [14:30]
Ruth Evans
Do you think that given the population pyramid of a country like Malawi, inevitably the focus is going to be on younger people and that older people often get overlooked or squeezed out? Especially in a resource strapped situation like this.
- [14:45]
Gerald Mantalu
We need to adapt. Now that people are living longer, we need to have deliberate policies that will accommodate old people and the economy needs to sustain them. We need to have some form of Social Security and health services to cover what the old need.
- [15:06]
Ruth Evans
But will already overstretched health and social protection services be able to cope with the new demands that come with longer lives? Only just over 10% of the population is currently covered by essential health and social protection services, a tiny proportion of the growing need. Gerald Mantalu is Director of Planning and Policy Development in the Ministry of Health.
- [15:29]
Gerald Mantalu
In the past, mostly I've been dealing with infectious diseases, malaria, with a lot of very highly cost effective interventions, affordable. But now when people are staying longer, they're suffering from chronic conditions, maybe multiple chronic conditions, and those are much more expensive to treat or manage. And they're also obviously lifelong. Mostly if you look at non communicable diseases as a block, they contribute to 33% of all sickness and deaths. So now comes down to the budget, like can the country afford that? But also population growth. It's got a lot of complexities with the social complications that an increased Population brings, what policy shifts should be made starting actually now, what kind of trade offs are we going to make? There's also the issue of dwindling donor financing. If you talk about the health sector, we're about 56% financed by donor resources. And now we already know that donor financing is declining and donors are already saying how much responsibility as a government are you going to take for providing health care?
- [16:35]
Ruth Evans
And as we've just heard, more than half of health care spending in Malawi comes from foreign donors. And the increase in life expectancy has largely come about about because of huge investments in treatments for hiv, tb, malaria and infant mortality. But recently, much of that development assistance has been feeling the squeeze from competing demands for humanitarian assistance elsewhere. By far the biggest donor has been the United States, which was, according to the US State Department, giving more than $350 million annually to Malawi, more than 13% of the total budget for 2024-25. Then in January, the US President Donald Trump announced a 90 day freeze on funding to the US Agency for International Development. This has sent shockwaves through Malawi, shutting down essential activities and putting continued supplies of life saving medication and emergency food distribution under threat. And this has happened at a time when the economy was already on its knees. With inflation above 23%, repeated currency devaluations and foreign exchange shortages.
- [17:48]
Lea Malekano
It's very challenging times for us here in Malawi they are calling it a 3F crisis. Shortage of food, shortage of forex and a shortage of fuel.
- [18:01]
Ruth Evans
Prices are going up every day in this climate.
- [18:03]
Lea Malekano
Exactly. The prices of mains have doubled and currently In Malaw, about 5.7 million people are expected to be affected by hunger. Malawi is also one of the countries most impacted by climate change, with cycles of drought and flood decimating the subsistence agriculture on which most people still depend.
- [18:28]
Ruth Evans
And of course an indication of that climate change has been the number of cyclones that Malawi has had to deal with in the last couple of years.
- [18:36]
Lea Malekano
Yes, recently Malawi had a Cyclone Freddie with millions of people homeless and people were also struggling to access medical assistance due to Cyclone Freddy.
- [18:48]
Ruth Evans
The challenges are multiple. They are multiple, with most Malawians depending on subsistence agriculture and GDP per capita only $481 last year. There are very few prospects for this landlocked country to export its way out of aid dependency. Masiko Mutemba is a health rights activist and in 2019 he became the National Community Health Ambassador, acting as a go between between communities and the government to advocate for better health care services in rural areas, primarily through a network of community health workers.
- [19:26]
Dr. Andrew Jamali
I think with the aging population we have other challenges which are coming up. For example, issues of operative care, issues of cancer which are on the increase, hypertension, stroke. How do we expand delivery of health care when we know that doctors, nurses, professionals, specialists, they're in short supply? Hence my push for community health workers, well trained, well monitored to make sure that they're able to deliver these basic services.
- [19:52]
Ruth Evans
Those are huge challenges. So is it just going to drive more people into poverty in old age or is there a way that government and donors can work together to alleviate those strains?
- [20:04]
Dr. Andrew Jamali
I'm hoping the development partners, much as they want to live, they have to think through on how a country like ours, because of these pressures, growing population but also aging people who are living longer, looking at the challenges because there are many, is to have an honest conversation. We need to manage the population moving forward.
- [20:25]
Ruth Evans
But that honest conversation about managing the population or having smaller families probably just got a whole lot more difficult after the new American administration suspended foreign aid in January, accusing USAID of mismanaging funds and promoting abortion and family planning.
- [20:47]
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- [21:32]
Deborah
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- [22:05]
Lea Malekano
This is the documentary from the BBC World Service. This road is very bad because of the rains.
- [22:14]
Ruth Evans
Yeah, we've been slipping and sliding all over the place in the mud. This is not very far from the can Capital and yet it seems like a very, very long way from the city center.
- [22:30]
Lea Malekano
We are now here at Maimba Mbandi, a civil society organization working with the elderly in Malawi. It was set up by a 25 year old debolambale.
- [22:41]
Deborah
At this center we provide food for the elderly people and also accommodation, including health services for the elderly people. When they get sick, we take them to the hospital.
- [22:55]
Ruth Evans
There's very little provision, if any, for state run homes for the elderly or even private ones and few people could afford them anyway.
- [23:14]
Deborah
Our elderly home currently is taking care of 84 elderly people. We are self funded, we do not have any funding, but we have some well wishers that see our work on social media and they visit us maybe to sponsor lunch or dinner. We mostly rely on farming, so these elderly people participate into farming. So through that we have food on the table and when we sell our farm producers we are able to have more money to take them to the hospital.
- [23:49]
Ruth Evans
At 25 years old, Deborah strikes me as a remarkable young woman.
- [23:54]
Deborah
I wouldn't lie. Looking after 84 elderly people, it's very hard. I get overwhelmed because of my age. I'm taking care of people that are in their 90s, 80s, people that have dementia. Sometimes I don't have the resources to take care of them. Their food three times in a day, it's very difficult, but it's my passion. It's something that I feel like I'm supposed to do. What we have achieved should give us hope for tomorrow.
- [24:22]
Ruth Evans
It's raining now on the tin roof. You can hear it. Traditionally Africa had the reputation of looking after its elderly, respecting elderly people. How much has that changed, do you.
- [24:32]
Deborah
Think that has changed because now people respect, maybe the early 50s, they're respected because they're taken as elders of the land, but not elderly people with gray hair because a lot of people do not have the right knowledge for elderly care and the diseases that affect elderly people. So a lot of people think that they are witches and they're not supposed to live when something bad happens. It's now the little children pointing fingers at the granny that this agogo, the granny is the one that has done this thing or right now. We've been facing climate change whereby the rain itself hasn't been the way it has been years back. But we have seen elderly people being accused of that. They are the ones that are stopping the rain. So abuse, they are increasing.
- [25:33]
Ruth Evans
This 72 year old man told me his story.
- [25:38]
Lea Malekano
He says they were living a very hard life in the villages that they came from. People were taking them as wizards who were living in fear that maybe one day people could kill them because of their attitude towards them as old people. That's why they found themselves here. He has 16 children, but the 16 children doesn't take care of him.
- [26:10]
Ruth Evans
Why not?
- [26:17]
Lea Malekano
Raised them, he supported them. But now they are not supporting him and he doesn't know why. Some of them, they are well to do. Some of them are struggling.
- [26:29]
Ruth Evans
Despite these challenges, the atmosphere at the centre seems joyous. Soon the men dressed in their Sunday best for the BBC World Service visit and the women in brightly coloured cloth wraps are all up on their feet, singing and dancing, demonstrating that there can be still plenty of life in those extra years.
- [26:51]
Lea Malekano
He's saying that they do aerobics and dancing as well so that our bodies can be fit. I enjoy being here.
- [27:06]
Ruth Evans
With the world's rapidly aging population. Some researchers, such as Professor Sarah Harper at Dr. Oxford Oxford University, now believe that it might be better to talk about healthy life expectancy at birth rather than just life expectancy.
- [27:22]
Sarah Harper
Healthy life expectancy is actually far more relevant. That really is what we should be striving for. Not an increase in the number of years, but an increase in the number of healthy years. The problem there is that healthy life expectancy is not as robust at the statistical level as life expectancy is. So different countries will measure it in different ways. We also have different ways of describing it. Is it disability free or is it, you know, how many years can one expect at the end of one's life to be free from disease? Or is it freedom across the life course? So it's very complicated and we need more robust measures.
- [28:01]
Ruth Evans
Ageing in high income countries has been.
- [28:03]
Lea Malekano
Studied for many years, but ageing in low income countries is not very well understood.
- [28:09]
Ruth Evans
The Malawi Longitudinal Study of Families and health is a 25 year collaborative study between the University of Pennsylvania and researchers in Malawi.
- [28:18]
Lea Malekano
Kondwan Katundo is a lecturer at the School of Global Health at Kamuzu University of Health Sciences in Malawi, helping to collect genetic and epigenetic information to understand the factors that help people to stay resilient in old age and maintain physical and mental health.
- [28:37]
Gerald Mantalu
We are evaluating the results from ongoing epigenetic analysis and these results will be matched with comprehensive social demographic data to provide a deep understanding on the environmental, the social and the biological factors associated with both healthy and unhealthy aging. We know that, for example, the African population and low and middle income countries aging is occurring at a higher rate. So this is a very important aspect of the study. But we also have an emerging concern of decline in cognitive function. And this is happening at a younger age than worldwide. Here in Malawi, compared to high income countries, research like this can help the health sector to get prepared for the growing older age group in addressing their health challenges as people are growing older.
- [29:29]
Ruth Evans
Deborah takes us to meet one man who has shown remarkable resilience as he's grown older.
- [29:34]
Deborah
We have come to see Gogo Simeon Biga. He's 101 years old.
- [29:40]
Ruth Evans
101?
- [29:40]
Deborah
Yes.
- [29:42]
Ruth Evans
And this little house that he lives in, this is something that the foundation helped him with?
- [29:47]
Deborah
Yes, we built the house he used to live in a very leaking house. He was neglected by his children, but unfortunately people plotted to kill him.
- [29:57]
Ruth Evans
To kill him?
- [29:58]
Deborah
Yes, to kill him. A lot of people don't have the knowledge of dementia. It's not something that people know that it's a disease. That's a very huge problem. So I think that's also one of the reasons why elderly people are abused. How are you?
- [30:20]
Lea Malekano
I am very well.
- [30:25]
Ruth Evans
At 101, Gogo Simeon bigger warmly welcomes us to his simple new home, sitting on a reed mat on the floor with his wife who's in her 70s.
- [30:37]
Lea Malekano
This is my second wife. My first wife died long time ago. I had three children with my first wife. With the second wife, he has seven children.
- [30:50]
Ruth Evans
Do your children look after you now that you are such a venerable old age?
- [30:56]
Dr. Andrew Jamali
I.
- [30:58]
Lea Malekano
They don't take care of me. They don't. When we were young, we used to help our parents. But the children, they don't have the heart to help us. It's not that they don't have the money that we need. They are just hat race. See the way I'm suffering. Where I was living, they burned my house. People were accusing us of witchcraft, chasing us out of the village. So we had to move to this place.
- [31:35]
Ruth Evans
In February 2024 Catholic bishops in Malawi called on the government to do more to protect the country's elderly, warning that many of them face violence and abuse. They said that in 2023 alone, 78 elderly people had been tortured and 25 killed for allegedly practicing witchcraft. Then in April last year, the national assembly passed the Older Persons Bill aimed at establishing a new framework for community based health care as well as providing monthly financial assistance for vulnerable elderly people like Gogo Biga who have no other means of support. These government cash transfers are supposed to be distributed by traditional village chiefs who identify those most in need in their communities.
- [32:25]
Lea Malekano
Gogo Biga says that I'm not receiving Any support from the government, the chiefs, they don't put us on the list of the beneficiaries. The only support that we depend on is from Maimba Mbande.
- [32:38]
Ruth Evans
Deborah, why is he not getting any assistance, do you think?
- [32:42]
Deborah
It's a leadership thing, especially in the villages, the chiefs take people that are not supposed to be helped, maybe their family members, and leave these people that really deserve the support.
- [32:57]
Ruth Evans
I put that allegation to Dr. Andrew Jamali at the government's National Planning Commission.
- [33:02]
Dr. Andrew Jamali
The programs are in place, but how impactful are they in the meantime? The truth of the matter is there's more that needs to be done.
- [33:09]
Ruth Evans
But Deborah believes, realistically, there's only so far government support can go.
- [33:14]
Deborah
Government, yes, is responsible for its citizens, but it's not only work for the government, it works for everyone to take care of the elderly people.
- [33:26]
Ruth Evans
So, Leah, have you been shocked that you've heard some of these stories?
- [33:30]
Lea Malekano
That's shocking to me. Some of the elderly persons that we spoke to, they have children who are working, but they are not able to assist their parents. Now, with a growing population, government cannot afford to support all these elderly persons. I have my father who is a 60 year old and he has stroke now and we have to pay his hospital bills each and every time. And this is the father who has shown us love, the little that we have. We are able to support him.
- [34:06]
Ruth Evans
Without continued donor support, there's a very real risk that the dramatic increase in life expectancy could be eroded if antiretroviral treatment and other essential health programmes stop, says Gerald Mantalu, director of Planning and Policy Development in the Ministry of Health.
- [34:23]
Gerald Mantalu
I think where we're at, Malawi needs to make some very tough decisions. Very, very tough decisions. You can expect so much more from government in the foreseeable future. So we're getting to a place where there really has to be a mindset shift about what is the expectation of citizens from their government and what should be the responsibility of citizens. You know, people that pay taxes are very, very few and they have to shoulder the bidding of very huge population. This is a country that's got a huge debt and where do you see any more additional funds coming to do? Like any, if you want to do, say, a social safety net program, like, the tax base is very small, donor funds are declining. Like, what can you possibly do? It's such a tough problem, to be honest.
- [35:13]
Ruth Evans
Dr. Andrew Jamali at the National Planning Commission is worried that despite the government's best efforts to mitigate the suspension of aid, the abrupt Halt to American assistance, combined with dwindling funding from other development partners may now undermine years of progress.
- [35:30]
Dr. Andrew Jamali
Truth of the matter is it's really tough. These are challenges that Malawi has to grapple with because we know that the support that we get for our own partners cannot be guaranteed for life. And so as a country, that's why we've put in place these kind of, you know, programs like if you look at Malawi 2063 or the gender policy, they're all addressing sustainability mechanisms for these kind of vulnerable population groups in terms of support that we must provide.
- [35:52]
Ruth Evans
How do you see your own old age?
- [35:57]
Dr. Andrew Jamali
That's an interesting question.
- [35:59]
Ruth Evans
Does it worry you? You have a good job here, you presumably have a pension to look forward to, but, you know, do you feel that you are going to be secure in your old age and have adequate services and provision? Or is it something that makes you feel quite uncertain about the future?
- [36:14]
Dr. Andrew Jamali
No, I wouldn't really be uncertain about the future. There's been quite a lot of tremendous improvement like you've observed. What needs to be done is to sustain and improve on the current pace that we are investing in terms of our health, in terms of our productivity. My worry has always been on the economy. As of now, almost 20% of the population is experiencing acute food insecurity and malnutrition is like the wellspring of all other forms of infections and diseases. And if this keeps increasing, particularly for younger population like the under 5s, and then we have starvation for older populations, then that compromises the quality of life. So what needs to be done is to make sure that the gains that we have accumulated over the years are maintained and really enhanced.
- [37:02]
Ruth Evans
So Leah, how do you see their future in Malawi with these changing demographics?
- [37:07]
Lea Malekano
They're looking at them, their future. They will have a tough time for them to have access to education, access to health services, access to clean water, access to electricity. They will have a tough time, I hear.
- [37:24]
Ruth Evans
Do you hope that your twins and your daughter will look after you in your old age?
- [37:28]
Lea Malekano
I hope that my children would be able to take care of us when we need that support in future. This is the documentary from the BBC world service and I am leah malikano.
- [37:46]
Ruth Evans
And I'm ruth evans and this has.
- [37:49]
Lea Malekano
Been been a ruth evans production for the BBC world service.
- [38:04]
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