Malawi

Malawi is poised to make significant gains in health and development, but faces challenges around the health of women and girls. Central to the success of these efforts is reproductive health and family planning. Though Malawi has achieved substantial increases in the percentage of women giving birth in a health facility with a skilled attendant, the country has one of the highest maternal mortality rates in the world. Access to family planning to help women space their children and build stronger and healthier families is limited, especially in rural communities. The average woman has six children during her fertile years.

Poor child health and infectious diseases threaten the country’s progress. While the good news is that Malawi is on track to achieve Millennium Development Goal 4 for improving child health, under-five mortality rates—especially among newborn infants—remain unacceptably high, and nutrition is a serious health and development problem. Despite significant progress, malaria is still the leading cause of mortality and morbidity, and Malawi continues to face a severe HIV epidemic with a current prevalence rate of 12 percent.

The development health goal for the U.S. in Malawi is to support a healthy population capable of strengthening its economy. The Malawi GHI Strategy builds on the success of PEPFAR and the President’s Malaria Initiative, while elevating the focus on strengthening health delivery systems and improving the wellbeing of women and girls.

Country Leadership: National Health Plan Priorities and Challenges

The Government of Malawi’s Ministry of Health and Development and its partners adopted a sector-wide approach to plan, finance, and monitor health programs to increase coordination and support government stewardship. A single, coordinated health strategy – the Program of Work II – is being finalized by the collaborators. The plan is structured around seven building blocks essential to the successful implementation of a national health care program. These building blocks focus on increasing health access for the rural poor and vulnerable groups such as women and children. They emphasize service delivery, service quality, and health systems strengthening.

GHI Malawi Strategy: Focus Areas

Under GHI, and in partnership with Malawi, the U.S. is implementing health programs in support of the Government of Malawi’s national health strategy. The overarching GHI country goal in Malawi is to increase access to quality health care to foster a healthier people able to participate in the country’s economic development. To achieve this goal, under the Malawi GHI Strategy, the U.S. will focus its efforts on three approaches to improving the health system in Malawi:

1. Improving human resources for health.

2. Addressing health infrastructure deficiencies.

3. Enhancing leadership, governance, management, and accountability.

These issues are among the most critical and difficult problems in Malawi and they significantly limit the country’s capacity for development. They also represent opportunities where U.S. financial and technical assistance could make the most significant and sustainable impact. Improving performance in these areas will have ripple effects across all areas of the health sector while also strengthening country capacity and ownership, complementing other funding sources, and encouraging evidence-based, transparent decision-making and resource allocation.

Improving Effectiveness and Efficiency through GHI Principles

The Malawi GHI Strategy outlines specific steps that will be taken to advance the GHI principles. These steps include:

• Implementing a women, girls, and gender equality approach across U.S. programs to focus on issues such as equitable access, empowerment and inclusion of women and girls, and engagement of men and boys.
• Integrating U.S.-supported services for HIV, malaria, family planning/reproductive health, maternal/neonate/child health, nutrition, and tuberculosis, to ensure a “one-stop-shop” approach to reach over eight million Malawians.
• Advancing country ownership through new leadership mentoring, promoting private sector involvement in improving health outcomes, supporting health policy and guideline development, and promoting social mobilization and governance at community levels.
• Supporting the Government of Malawi to provide sustained, sufficient, and equitably distributed human resources, and to produce highly motivated and skilled staff.
• Working with the Government of Malawi to assess plans to upgrade critical health facilities to maximize service delivery effectiveness and expand access to hard-to-reach communities.
• Communicating with key multilateral organizations and coordinating efforts with partners and government on health sector priorities and activities, including the Health Donor Group and the Global Fund Country Coordinating Mechanism.
• Supporting national government efforts to coordinate the collection and use of reliable health information across health areas.
• Providing assistance in the development of national health research agendas to further align U.S. and Government of Malawi research priorities.

GHI in Action:

Improving Health in Rural Malawi

In a country where 83 percent of 13 million people live in rural, hard-to-reach and underserved areas, Malawians often walk long distances for health services, but sometimes never see a provider. Critical shortages in trained health service providers and a lack of support for those who are on duty results in vacant or overburdened health facilities that deliver poor care. Women and children who are unable to travel long distances to health facilities rely heavily on community-based health services.

Through the Malawi GHI Strategy, and under direct supervision of the Malawi Ministry of Health staff and guidelines, the U.S. is implementing locally developed and built electronic and mobile health systems that support health care workers at the local level. In health facilities, the U.S. supports use of real-time electronic data systems to assist health workers in reviewing patient records, identifying critical danger signs, and acting promptly to more efficiently deliver lifesaving and evidence-based care.

In communities, a cadre of health workers supported, trained, and retained by the U.S., travel door-to-door using mobile technology to take integrated services, including HIV testing and counseling, evaluations of nutrition status, family planning, and tuberculosis screening services, to remote areas where most Malawians live. To support the Government of Malawi’s desire to use new technologies, GHI supports community workers’ use of cell phones to report health information more rapidly and efficiently.

Within communities, health tasks have been shifted by the Government of Malawi to expand capability to report health threats. Besides the community health workers, 120 U.S. Peace Corps volunteers across Malawi serve as eyes and ears in remote communities, alerting district level decision makers about missed health opportunities and reporting progress.